Renal Failure Risk Equation Shows Poorly Calibrated to Predict ESKD in Children with CKD

According to data published in , the renal failure risk equation showed poor calibration in predicting end-stage renal disease in children with chronic kidney disease. American Journal of Kidney Disease.

Gayathri Menon

“As epidemiologists, we seek to support pediatric nephrologists by developing and evaluating the usefulness and validity of clinical tools.” Gayathri Menon, MHS, When Derek K. Ng, PhD, “The renal failure risk equation (KFRE) is the most common clinical prognostic tool for nephrologists,” he told Helio, from the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. The structure of KFRE suggests that it may not be suitable for pediatric practice. showed discrimination, i.e., those who ultimately experienced ESKD had a higher probability of renal failure as estimated by KFRE than those who did not experience ESKD, although instrument calibration was It was not well characterized.Calibration refers to whether the predicted risk corresponds to the actual risk observed in the data.Ongoing multicenter pediatric chronic kidney disease (CKiD) The cohort was well suited to answer this calibration question because of its long-term follow-up to end-stage renal disease.”

Researchers replicated the analytical structure of CKiD for 817 children with CKD. Their analysis extended follow-up and included estimation of albuminuria using a pediatric-based formula.

Additionally, researchers used a formal statistical test to quantify the calibration of KFRE in the cohort, which had not been performed in CKiD. Patients provided data to calculate the four-variable KFRE. A total of 799 patients completed the data for the 8-variable calculation.

The researchers calculated the 2- and 5-year risks observed on KFRE for 4-variable and 8-variable equations.

Ultimately, the analysis revealed that the predicted KFRE risk differed from the observed risk. KFRE overestimated the observed risk among those with high KRFE scores on 2-year (4-variable and 8-variable) KFRE. Similarly, KFRE underestimated risk for lower probabilities predicted by the 5-year equation and overestimated risk for higher probabilities. The calibration was poor, but the researchers wrote that discrimination was high.

Derek K. Ng

“KFRE did not show strong calibration in the CKiD cohort,” Menon and Ng told Healio. “However, there are other pediatric-specific risk calculators available to pediatric nephrologists. A joint collaboration between the North American CKiD and the European ESCAPE pediatric cohort has developed a risk calculator using CKD diagnosis, GFR and proteinuria. , American Journal of Kidney Disease in 2018. The CKiD study also published an enhanced calculator with more predictors. American Journal of Kidney Disease Both formulas are available online (https://statepi.jhsph.edu/ckid/investigator-resources/ckid-calculators/), the latter on the National Kidney Foundation website (https://www.kidney) can. .org/professionals/kdoqi/gfr_calculatorPedRisk). As with any clinical tool, each calculator has strengths and weaknesses, but these risk calculators were developed for children with CKD. “