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Papasotiriou M, Stangou M, Chlorogiannis D, Marinaki S, Xydakis D, Sampani E, Lioulios G, Kapsia E, Zerbala S, Koukoulaki M, Moustakas G, Fokas S, Dounousi E, Duni A, Papadaki A, Damianakis N, Bacharaki D, Stylianou K, Gakiopoulou H, Liapis G, Sakellaropoulos G, Papachristou E, Boletis I, Papagianni A, Goumenos DS. Validation of the International IgA Nephropathy Prediction Tool in the Greek Registry of IgA Nephropathy. Front Med (Lausanne) 2022; 9:778464. [PMID: 35242773 PMCID: PMC8885590 DOI: 10.3389/fmed.2022.778464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Immunoglobulin A nephropathy (IgAN) is among the commonest glomerulonephritides in Greece and an important cause of end-stage kidney disease (ESKD) with an insidious chronic course. Thus, the recently published International IgAN prediction tool could potentially provide valuable risk stratification and guide the appropriate treatment module. This study aimed to externally validate this prediction tool using a patient cohort from the IgAN registry of the Greek Society of Nephrology. Methods We validated the predictive performance of the two full models (with or without race) derived from the International IgAN Prediction Tool study in the Greek Society of Nephrology registry of patients with IgAN using external validation of survival prediction models (Royston and Altman). The discrimination and calibration of the models were tested using the C-statistics and stratified analysis, coefficient of determination (RD2) for model fit, and the regression coefficient of the linear predictor (βPI), respectively. Results The study included 264 patients with a median age of 39 (30–51) years where 65.2% are men. All patients were of Caucasian origin. The 5-year risk of the primary outcome (50% reduction in estimated glomerular filtration rate or ESKD) was 8%. The RD2 for the full models with and without race when applied to our cohort was 39 and 35%, respectively, and both were higher than the reported RD2 for the models applied to the original validation cohorts (26.3, 25.3, and 35.3%, respectively). Harrel's C statistic for the full model with race was 0.71, and for the model without race was 0.70. Renal survival curves in the subgroups (<16th, ~16 to <50th, ~50 to <84th, and >84th percentiles of linear predictor) showed adequate separation. However, the calibration proved not to be acceptable for both the models, and the risk probability was overestimated by the model. Conclusions The two full models with or without race were shown to accurately distinguish the highest and higher risk patients from patients with low and intermediate risk for disease progression in the Greek registry of IgAN.
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Affiliation(s)
- Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | - Maria Stangou
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thassaloniki, Thessaloniki, Greece
| | | | - Smaragdi Marinaki
- Department of Nephrology and Kidney Transplantation, Laiko General Hospital of Athens, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Xydakis
- Department of Nephrology, General Hospital of Heraklion "Venizeleio-Pananeio", Heraklion, Greece
| | - Erasmia Sampani
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thassaloniki, Thessaloniki, Greece
| | - Georgios Lioulios
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thassaloniki, Thessaloniki, Greece
| | - Eleni Kapsia
- Department of Nephrology and Kidney Transplantation, Laiko General Hospital of Athens, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Synodi Zerbala
- Department of Nephrology, General Hospital of Nikaia, Piraeus, Greece
| | - Maria Koukoulaki
- Department of Nephrology, General Hospital of Nikaia, Piraeus, Greece
| | - Georgios Moustakas
- Department of Nephrology, Gennimatas General Hospital of Athens, Athens, Greece
| | - Stavros Fokas
- Department of Nephrology, Gennimatas General Hospital of Athens, Athens, Greece
| | - Evangelia Dounousi
- Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Anila Duni
- Department of Nephrology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Antonia Papadaki
- Department of Nephrology, General Hospital of Chania, Chania, Greece
| | | | - Dimitra Bacharaki
- Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Centre, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kostas Stylianou
- Department of Nephrology, University of Crete, Heraklion, Greece
| | - Hariklia Gakiopoulou
- First Department of Pathology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Liapis
- First Department of Pathology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Evangelos Papachristou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
| | - Ioannis Boletis
- Department of Nephrology and Kidney Transplantation, Laiko General Hospital of Athens, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration General Hospital, Aristotle University of Thassaloniki, Thessaloniki, Greece
| | - Dimitrios S Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, Greece
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