Tool IDs Those at Elevated CKD Risk
A new eight-factor algorithm helps predict which patients are most likely to develop CKD within a decade. The model is designed to be used for individuals who have healthy kidneys now.
It is based on data from two population-based cardiovascular studies that created a combined cohort of 14,155 men and women. At baseline, all participants were aged 45 and older (mean 57.6 years) with an estimated glomerular filtration rate of 60 mL/min/1.732 or higher. Overall, CKD developed in 1,605 subjects (11.3%) over nine years, according to a report in the Archives of Internal Medicine (2008;168:2466-2473).
“We discovered that a scoring system that included eight key risk factors — older age, anemia, female sex, hypertension, diabetes, peripheral vascular disease (PVD), and any history of heart failure or cardiovascular disease (CVD) — accurately predicted which of the older patients would proceed to CKD and which would not,” reported co-author Heejung Bang, PhD, an associate professor of biostatistics and epidemiology at Weill Cornell Medical College in New York.
The model assigns one, two, or three points for having an age of 50-59, 60-69, or 70 years or more, respectively, and one point for each of the other seven factors. Patients who developed CKD tended to be almost five years older than those who did not.
They also were more likely to be white and to have diabetes, PVD, hypertension, and/or a history of CVD. A score of 3 or higher captured approximately 70% of incident cases and accurately predicted a 17% risk of developing CKD, the researchers reported.
“Importantly, we were able to validate the accuracy of the score across different cohorts, suggesting that it remains consistent in a variety of contexts,” noted lead author Abhijit V Kshirsagar, MD, MPH, associate professor of medicine at the University of North Carolina Kidney Center at Chapel Hill. “Each of the eight components that make up the score is also easy to identify or quickly assess during a clinician-patient interview.
“Not everyone with a score of 3 or higher will develop CKD,” he added. “They are just at a higher than average risk for kidney disease in the future.” But he recommended that such a score should trigger a conversation encouraging patients to address their sugar intake, BP and other cardiovascular risks.