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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis</title><author><name sortKey="Tangri, Navdeep" sort="Tangri, Navdeep" uniqKey="Tangri N" first="Navdeep" last="Tangri">Navdeep Tangri</name></author><author><name sortKey="Grams, Morgan E" sort="Grams, Morgan E" uniqKey="Grams M" first="Morgan E." last="Grams">Morgan E. Grams</name></author><author><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S." last="Levey">Andrew S. Levey</name></author><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name></author><author><name sortKey="Appel, Lawrence" sort="Appel, Lawrence" uniqKey="Appel L" first="Lawrence" last="Appel">Lawrence Appel</name></author><author><name sortKey="Astor, Brad C" sort="Astor, Brad C" uniqKey="Astor B" first="Brad C." last="Astor">Brad C. Astor</name></author><author><name sortKey="Chodick, Gabriel" sort="Chodick, Gabriel" uniqKey="Chodick G" first="Gabriel" last="Chodick">Gabriel Chodick</name></author><author><name sortKey="Collins, Allan J" sort="Collins, Allan J" uniqKey="Collins A" first="Allan J." last="Collins">Allan J. Collins</name></author><author><name sortKey="Djurdjev, Ognjenka" sort="Djurdjev, Ognjenka" uniqKey="Djurdjev O" first="Ognjenka" last="Djurdjev">Ognjenka Djurdjev</name></author><author><name sortKey="Elley, C Raina" sort="Elley, C Raina" uniqKey="Elley C" first="C. Raina" last="Elley">C. Raina Elley</name></author><author><name sortKey="Evans, Marie" sort="Evans, Marie" uniqKey="Evans M" first="Marie" last="Evans">Marie Evans</name></author><author><name sortKey="Garg, Amit X" sort="Garg, Amit X" uniqKey="Garg A" first="Amit X." last="Garg">Amit X. Garg</name></author><author><name sortKey="Hallan, Stein I" sort="Hallan, Stein I" uniqKey="Hallan S" first="Stein I." last="Hallan">Stein I. Hallan</name></author><author><name sortKey="Inker, Lesley" sort="Inker, Lesley" uniqKey="Inker L" first="Lesley" last="Inker">Lesley Inker</name></author><author><name sortKey="Ito, Sadayoshi" sort="Ito, Sadayoshi" uniqKey="Ito S" first="Sadayoshi" last="Ito">Sadayoshi Ito</name></author><author><name sortKey="Jee, Sun Ha" sort="Jee, Sun Ha" uniqKey="Jee S" first="Sun Ha" last="Jee">Sun Ha Jee</name></author><author><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name></author><author><name sortKey="Kronenberg, Florian" sort="Kronenberg, Florian" uniqKey="Kronenberg F" first="Florian" last="Kronenberg">Florian Kronenberg</name></author><author><name sortKey="Lambers Heerspink, Hiddo J" sort="Lambers Heerspink, Hiddo J" uniqKey="Lambers Heerspink H" first="Hiddo J." last="Lambers Heerspink">Hiddo J. Lambers Heerspink</name></author><author><name sortKey="Marks, Angharad" sort="Marks, Angharad" uniqKey="Marks A" first="Angharad" last="Marks">Angharad Marks</name></author><author><name sortKey="Nadkarni, Girish N" sort="Nadkarni, Girish N" uniqKey="Nadkarni G" first="Girish N." last="Nadkarni">Girish N. Nadkarni</name></author><author><name sortKey="Navaneethan, Sankar D" sort="Navaneethan, Sankar D" uniqKey="Navaneethan S" first="Sankar D." last="Navaneethan">Sankar D. Navaneethan</name></author><author><name sortKey="Nelson, Robert G" sort="Nelson, Robert G" uniqKey="Nelson R" first="Robert G." last="Nelson">Robert G. Nelson</name></author><author><name sortKey="Titze, Stephanie" sort="Titze, Stephanie" uniqKey="Titze S" first="Stephanie" last="Titze">Stephanie Titze</name></author><author><name sortKey="Sarnak, Mark J" sort="Sarnak, Mark J" uniqKey="Sarnak M" first="Mark J." last="Sarnak">Mark J. Sarnak</name></author><author><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></author><author><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26757465</idno><idno type="pmc">4752167</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752167</idno><idno type="RBID">PMC:4752167</idno><idno type="doi">10.1001/jama.2015.18202</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001F43</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F43</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis</title><author><name sortKey="Tangri, Navdeep" sort="Tangri, Navdeep" uniqKey="Tangri N" first="Navdeep" last="Tangri">Navdeep Tangri</name></author><author><name sortKey="Grams, Morgan E" sort="Grams, Morgan E" uniqKey="Grams M" first="Morgan E." last="Grams">Morgan E. Grams</name></author><author><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S." last="Levey">Andrew S. Levey</name></author><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name></author><author><name sortKey="Appel, Lawrence" sort="Appel, Lawrence" uniqKey="Appel L" first="Lawrence" last="Appel">Lawrence Appel</name></author><author><name sortKey="Astor, Brad C" sort="Astor, Brad C" uniqKey="Astor B" first="Brad C." last="Astor">Brad C. Astor</name></author><author><name sortKey="Chodick, Gabriel" sort="Chodick, Gabriel" uniqKey="Chodick G" first="Gabriel" last="Chodick">Gabriel Chodick</name></author><author><name sortKey="Collins, Allan J" sort="Collins, Allan J" uniqKey="Collins A" first="Allan J." last="Collins">Allan J. Collins</name></author><author><name sortKey="Djurdjev, Ognjenka" sort="Djurdjev, Ognjenka" uniqKey="Djurdjev O" first="Ognjenka" last="Djurdjev">Ognjenka Djurdjev</name></author><author><name sortKey="Elley, C Raina" sort="Elley, C Raina" uniqKey="Elley C" first="C. Raina" last="Elley">C. Raina Elley</name></author><author><name sortKey="Evans, Marie" sort="Evans, Marie" uniqKey="Evans M" first="Marie" last="Evans">Marie Evans</name></author><author><name sortKey="Garg, Amit X" sort="Garg, Amit X" uniqKey="Garg A" first="Amit X." last="Garg">Amit X. Garg</name></author><author><name sortKey="Hallan, Stein I" sort="Hallan, Stein I" uniqKey="Hallan S" first="Stein I." last="Hallan">Stein I. Hallan</name></author><author><name sortKey="Inker, Lesley" sort="Inker, Lesley" uniqKey="Inker L" first="Lesley" last="Inker">Lesley Inker</name></author><author><name sortKey="Ito, Sadayoshi" sort="Ito, Sadayoshi" uniqKey="Ito S" first="Sadayoshi" last="Ito">Sadayoshi Ito</name></author><author><name sortKey="Jee, Sun Ha" sort="Jee, Sun Ha" uniqKey="Jee S" first="Sun Ha" last="Jee">Sun Ha Jee</name></author><author><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name></author><author><name sortKey="Kronenberg, Florian" sort="Kronenberg, Florian" uniqKey="Kronenberg F" first="Florian" last="Kronenberg">Florian Kronenberg</name></author><author><name sortKey="Lambers Heerspink, Hiddo J" sort="Lambers Heerspink, Hiddo J" uniqKey="Lambers Heerspink H" first="Hiddo J." last="Lambers Heerspink">Hiddo J. Lambers Heerspink</name></author><author><name sortKey="Marks, Angharad" sort="Marks, Angharad" uniqKey="Marks A" first="Angharad" last="Marks">Angharad Marks</name></author><author><name sortKey="Nadkarni, Girish N" sort="Nadkarni, Girish N" uniqKey="Nadkarni G" first="Girish N." last="Nadkarni">Girish N. Nadkarni</name></author><author><name sortKey="Navaneethan, Sankar D" sort="Navaneethan, Sankar D" uniqKey="Navaneethan S" first="Sankar D." last="Navaneethan">Sankar D. Navaneethan</name></author><author><name sortKey="Nelson, Robert G" sort="Nelson, Robert G" uniqKey="Nelson R" first="Robert G." last="Nelson">Robert G. Nelson</name></author><author><name sortKey="Titze, Stephanie" sort="Titze, Stephanie" uniqKey="Titze S" first="Stephanie" last="Titze">Stephanie Titze</name></author><author><name sortKey="Sarnak, Mark J" sort="Sarnak, Mark J" uniqKey="Sarnak M" first="Mark J." last="Sarnak">Mark J. Sarnak</name></author><author><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></author><author><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name></author></analytic><series><title level="j">JAMA</title><idno type="ISSN">0098-7484</idno><idno type="eISSN">1538-3598</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Importance</title><p id="P1">Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations (KFREs) were previously developed and validated in two Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To evaluate the accuracy of the KFREs across different geographic regions and patient populations through individual-participant data meta-analysis.</p></sec><sec id="S3"><title>Data Sources</title><p id="P3">Thirty-one cohorts, including 721,357 participants with CKD Stages 3–5 in over 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014.</p></sec><sec id="S4"><title>Study Selection</title><p id="P4">Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease.</p></sec><sec id="S5"><title>Data Extraction and Synthesis</title><p id="P5">Data were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original KFREs, cohort-specific hazard ratios were estimated, and combined in meta-analysis to form new “pooled” KFREs. Original and pooled equation performance was compared, and the need for regional calibration factors was assessed.</p></sec><sec id="S6"><title>Main Outcome and Measure</title><p id="P6">Kidney failure (treatment by dialysis or kidney transplantation).</p></sec><sec id="S7"><title>Results</title><p id="P7">During a median follow-up of 4 years, 23,829 cases of kidney failure were observed. The original KFREs achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overall C statistic, 0.90 (95% CI 0.89–0.92) at 2 years and 0.88 (95% CI 0.86–0.90) at 5 years); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original KFREs overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12/15 and 10/13 non-North American cohorts at 2 and 5 years, respectively (p=0.04 and p=0.02).</p></sec><sec id="S8"><title>Conclusions and Relevance</title><p id="P8">KFREs developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id><journal-id journal-id-type="pubmed-jr-id">5346</journal-id><journal-id journal-id-type="nlm-ta">JAMA</journal-id><journal-id journal-id-type="iso-abbrev">JAMA</journal-id><journal-title-group><journal-title>JAMA</journal-title></journal-title-group><issn pub-type="ppub">0098-7484</issn><issn pub-type="epub">1538-3598</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26757465</article-id><article-id pub-id-type="pmc">4752167</article-id><article-id pub-id-type="doi">10.1001/jama.2015.18202</article-id><article-id pub-id-type="manuscript">NIHMS756538</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tangri</surname><given-names>Navdeep</given-names></name><degrees>MD, PhD, FRCPC</degrees></contrib><contrib contrib-type="author"><name><surname>Grams</surname><given-names>Morgan E.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Levey</surname><given-names>Andrew S.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Coresh</surname><given-names>Josef</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Appel</surname><given-names>Lawrence</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Astor</surname><given-names>Brad C.</given-names></name><degrees>PhD, MPH</degrees></contrib><contrib contrib-type="author"><name><surname>Chodick</surname><given-names>Gabriel</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Collins</surname><given-names>Allan J.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Djurdjev</surname><given-names>Ognjenka</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Elley</surname><given-names>C. Raina</given-names></name><degrees>MBCHB, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Evans</surname><given-names>Marie</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Garg</surname><given-names>Amit X.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Hallan</surname><given-names>Stein I.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Inker</surname><given-names>Lesley</given-names></name><degrees>MD, MS</degrees></contrib><contrib contrib-type="author"><name><surname>Ito</surname><given-names>Sadayoshi</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Jee</surname><given-names>Sun Ha</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Kovesdy</surname><given-names>Csaba P.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Kronenberg</surname><given-names>Florian</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Lambers Heerspink</surname><given-names>Hiddo J.</given-names></name><degrees>PharmD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Marks</surname><given-names>Angharad</given-names></name><degrees>MBBCh, MRCP, MSc, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Nadkarni</surname><given-names>Girish N.</given-names></name><degrees>MD, MPH</degrees></contrib><contrib contrib-type="author"><name><surname>Navaneethan</surname><given-names>Sankar D.</given-names></name><degrees>MD, MPH</degrees></contrib><contrib contrib-type="author"><name><surname>Nelson</surname><given-names>Robert G.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Titze</surname><given-names>Stephanie</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Sarnak</surname><given-names>Mark J.</given-names></name><degrees>MD, MS</degrees></contrib><contrib contrib-type="author"><name><surname>Stengel</surname><given-names>Benedicte</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Woodward</surname><given-names>Mark</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Iseki</surname><given-names>Kunitoshi</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><collab>for the CKD Prognosis Consortium</collab></contrib><aff id="A1">Department of Medicine and Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada (N Tangri); Johns Hopkins Medical Institutions, Baltimore, MD (M Grams, LJ Appel); Division of Nephrology at Tufts Medical Center, Boston, MA USA (AS Levey, MJ Sarnak); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (J Coresh); Department of Medicine, University of Wisconsin School of Medicine and Public Health, and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA (BC Astor); Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G Chodick); Chronic Disease Research Group, Minneapolis Medical Research Foundation, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA (AJ Collins); Department of Measurement & Reporting, Provincial Health Service Authority, Vancouver, British Columbia, Canada (O Djurdjev); Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand (CR Elley); Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden (M Evans); Departments of Medicine and Epidemiology and Biostatistics, Western University, and Institute for Clinical Evaluative Sciences, Ontario, Canada (AX Garg); Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, and Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway (SI Hallan); Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine, Sendai, Japan (S Ito); Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea (SH Jee); Memphis Veterans Affairs Medical Center, Memphis, TN and University of Tennessee Health Science Center, Memphis, TN, USA (CP Kovesdy); Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria (F Kronenberg); Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (HJ Lambers Heerspink); Division of Applied Health Sciences, University of Aberdeen, and NHS Grampian, Foresterhill, Aberdeen, UK (A Marks);Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA (GN Nadkarni); Division of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH (SD Navaneethan); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ (RG Nelson); Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany (S Titze); Inserm UMR1018, CESP Center for Research in Epidemiology and Population Health, Team 5, Villejuif, France, UVSQ and UMRS 1018, Paris-Sud University, Villejuif, France (B Stengel); The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK, The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia, and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (M Woodward); Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan (K Iseki)</aff></contrib-group><author-notes><corresp id="cor1">Corresponding Author: Chronic Kidney Disease Prognosis Consortium Data Coordinating Center (Principal Investigator, Josef Coresh, MD, PhD), 2024 E. Monument Street, Baltimore, MD 21287; Tel: 410-955-9917, Fax: 410-955-8086, <email>ckdpc@jhmi.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>4</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="ppub"><day>12</day><month>1</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>12</day><month>1</month><year>2017</year></pub-date><volume>315</volume><issue>2</issue><fpage>164</fpage><lpage>174</lpage><pmc-comment>elocation-id from pubmed: 10.1001/jama.2015.18202</pmc-comment>
<abstract><sec id="S1"><title>Importance</title><p id="P1">Identifying patients at risk of chronic kidney disease (CKD) progression may facilitate more optimal nephrology care. Kidney failure risk equations (KFREs) were previously developed and validated in two Canadian cohorts. Validation in other regions and in CKD populations not under the care of a nephrologist is needed.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To evaluate the accuracy of the KFREs across different geographic regions and patient populations through individual-participant data meta-analysis.</p></sec><sec id="S3"><title>Data Sources</title><p id="P3">Thirty-one cohorts, including 721,357 participants with CKD Stages 3–5 in over 30 countries spanning 4 continents, were studied. These cohorts collected data from 1982 through 2014.</p></sec><sec id="S4"><title>Study Selection</title><p id="P4">Cohorts participating in the CKD Prognosis Consortium with data on end-stage renal disease.</p></sec><sec id="S5"><title>Data Extraction and Synthesis</title><p id="P5">Data were obtained and statistical analyses were performed between July 2012 and June 2015. Using the risk factors from the original KFREs, cohort-specific hazard ratios were estimated, and combined in meta-analysis to form new “pooled” KFREs. Original and pooled equation performance was compared, and the need for regional calibration factors was assessed.</p></sec><sec id="S6"><title>Main Outcome and Measure</title><p id="P6">Kidney failure (treatment by dialysis or kidney transplantation).</p></sec><sec id="S7"><title>Results</title><p id="P7">During a median follow-up of 4 years, 23,829 cases of kidney failure were observed. The original KFREs achieved excellent discrimination (ability to differentiate those who developed kidney failure from those who did not) across all cohorts (overall C statistic, 0.90 (95% CI 0.89–0.92) at 2 years and 0.88 (95% CI 0.86–0.90) at 5 years); discrimination in subgroups by age, race, and diabetes status was similar. There was no improvement with the pooled equations. Calibration (the difference between observed and predicted risk) was adequate in North American cohorts, but the original KFREs overestimated risk in some non-North American cohorts. Addition of a calibration factor that lowered the baseline risk by 32.9% at 2 years and 16.5% at 5 years improved the calibration in 12/15 and 10/13 non-North American cohorts at 2 and 5 years, respectively (p=0.04 and p=0.02).</p></sec><sec id="S8"><title>Conclusions and Relevance</title><p id="P8">KFREs developed in a Canadian population showed high discrimination and adequate calibration when validated in 31 multinational cohorts. However, in some regions the addition of a calibration factor may be necessary.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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