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Abstract: TH-PO890

Risk Prediction: CKD Staging Is the Beginning, Not the End

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Grams, Morgan, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Sang, Yingying, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Ballew, Shoshana, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Matsushita, Kunihiro, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States
  • Coresh, Josef, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
Background

The stages of chronic kidney disease reflect risk of subsequent adverse kidney outcomes. The heterogeneity of risk within each GFR and ACR stage is yet uncertain.

Methods

Using deidentified electronic health record data from Optum Labs Data Warehouse on patients with eGFR and albuminuria (urine ACR, PCR, or dipstick protein) within a two-year window. Albuminuria was harmonized to ACR levels for A-staging (ckdpcrisk.org/pcr2acr). We used the kidney-failure risk equation (ckdpcrisk.org/kidneyfailurerisk) to estimate the 2-year risk of kidney failure in 350,232 patients with eGFR <60 ml/min/1.73m2. We used the 40% eGFR decline calculator (ckdpcrisk.org/gfrdecline40) to estimate the 3-year risk of 40% decline in eGFR in 1,365,272 patients with eGFR ≥15 ml/min/1.73m2. We plotted the distribution of predicted risk within each G- and A-stage.

Results

The patients in the kidney failure risk population had a mean age 73 (SD 11) years; 39% were men; and there were 13,623 kidney failure events over mean follow-up of 3.4 years. The 40% decline population had a mean age of 58 (SD 15) years; 42% were men; and there were 33,257 events over a mean follow-up of 3 years. Risk of adverse outcomes increased with higher G- and A-stage. Within each stage; however, there was heterogeneity in predicted risk of adverse outcomes. Some stages contained risk distributions that spanned risk thresholds for action. For example, G5A1, G5A2, and G4A3 all contained patients with 2-year kidney failure risk above and below 20%, the suggested threshold for referral for vascular access/transplant evaluation. Risk overlap between stages was even greater when using the 40% decline calculator, with nearly all CKD stages spanning multiple risk categories.

Conclusion

CKD staging is useful as an initial tool for estimating risk of adverse outcomes but can be enhanced with use of appropriate risk prediction tools for a more nuanced estimate of future kidney failure and eGFR decline. Some strategies for risk-guided care have been developed and the potential for others should be tested using modeling and outcomes studies.

Funding

  • NIDDK Support