1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
3Asia Diabetes Foundation, Hong Kong SAR, China
Copyright © 2024 Korean Diabetes Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
Lee-Ling Lim has been international editorial board members of the Diabetes & Metabolism Journal since 2022. She was not involved in the review process of this article. Otherwise, there was no conflict of interest.
Ying-Guat Ooi and Shireene R. Vethakkan report no conflict of interest; Tharsini Sarvanandan reports receiving honoraria for giving lectures from Novo Nordisk; Nicholas Ken Yoong Hee reports receiving honoraria for giving lectures from AstraZeneca, Novo Nordisk and Zuellig Pharma; Quan-Hziung Lim reports receiving honoraria for giving lectures from AstraZeneca, Boehringer Ingelheim, Novo Nordisk and Zuellig Pharma; Sharmila S. Paramasivam reports receiving honoraria for consultancy or giving lectures from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Merck, Novo Nordisk and Zuellig Pharma; Jeyakantha Ratnasingam reports receiving honoraria for consultancy or giving lectures from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Sanofi, Servier, Novartis, Ipsen and Zuellig Pharma; Soo-Kun Lim reports receiving grants and/or honoraria for consultancy or giving lectures from Abbott, AstraZeneca, Astellas, Baxter, Boehringer Ingelheim, Duopharma, Fresenius-Kabi, MSD, Novartis, Novo Nordisk, Roche, Sanofi and Taisho; Lee-Ling Lim reports receiving grants and/or honoraria for consultancy or giving lectures from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Novartis, Novo Nordisk, Roche, Sanofi, Servier and Zuellig Pharma.
FUNDING
This work was supported by the University of Malaya (UM) International Collaboration Grant (Grant number: ST048-2023). The funding source did not have any role in the design, interpretation of the study or the decision to publish the results.
Study; Region | Study characteristics | Study design and aim | Key findings | KFRE, C statistic (95% CI) |
---|---|---|---|---|
Tangri et al. (2016) [59]; North America & Europe | a) 721,357 adults (40% had diabetes) | a) Meta-analysis | a) Excellent discrimination and appropriate cali-bration (death not treated as competing risk) | a) 4- and 8-variable 2-year score: 0.90 (0.89–0.92) |
b) Multinational cohorts from Chronic Kidney Disease Prognosis Consortium (CKD-PC) | b) Validation and recalibration for non-USA/Canada cohorts | |||
c) Mean±SD eGFR: 46±11 mL/min/1.73 m2 | b) Addition of a recalibration factor optimized performance in non-USA/Canada populations | b) 4- and 8-variable 5-year: 0.88 (0.86–0.90) | ||
d) 40% has baseline urinary ACR of ≥30 mg/g | ||||
e) Mean±SD age: 74±10 years | ||||
f) Men 77% | ||||
Lennartz et al. (2016) [60]; Germany | a) 403 adults | a) Prospective cohorts | a) Excellent discrimination and calibration | a) 4-variable 3-year score: 0.91 (0.83–0.99) |
b) Referral to tertiary nephrology care center | b) Validation | b) Addition of ultrasound markers did not improve performance | ||
c) Mean±SD eGFR: 55.7±32 mL/min/1.73 m2 | c) Addition of ultrasound markers: RRI or DI-RISK | |||
d) Median urinary ACR: 44 mg/g (IQR, 15–204) | ||||
e) Mean±SD age: 60±15 years | ||||
f) Men 58% | ||||
g) Mean±SD RRI: 72±9 | ||||
h) Mean±SD DI-RISK: 8±5 | ||||
Major et al. (2019) [61]; United Kingdom | a) 35,539 adults (31.5% had diabetes) | a) Retrospective cohort | a) Excellent discrimination (death not treated as competing risk) | a) 4-variable 2-year score: 0.93 (0.91–0.96) |
b) Primary care CKD population | b) Validation in primary care setting and clinical utility | |||
c) Median eGFR: 51 mL/min/1.73 m2 (IQR, 43–56) | b) Referral criteria based on 5-year risk of ≥5% and/or an urinary ACR of ≥70 mg/mmol is time and cost-effective | b) 4-variable 5-year score: 0.93 (0.91–0.94) | ||
d) Median urinary ACR: 3.2 mg/mmol (IQR, 1.2–8.0) | ||||
e) Mean±SD age: 76±10 years | ||||
f) Men 43% | ||||
Hallan et al. (2019) [62]; USA | a) 1,188 elderly (17% had diabetes) | a) Retrospective cohort | a) Well calibrated with excellent discrimination | a) 4-variable 5-year score: 0.88 (0.86–0.90) |
b) General population-based data | b) Validation of both KFRE and MREK in elderly | b) Recommend using both MREK and KFRE to decide whether to prepare for RRT in elderly people with advanced CKD | ||
c) Mean±SD eGFR: 36±8 mL/min/1.73 m2 | ||||
d) Mean±SD urinary ACR: 7.1±18.7 mg/mmol | ||||
e) Mean±SD age: 80±6.8 years | ||||
f) Men 47% | ||||
Wang et al. (2019) [63]; Singapore | a) 17,271 adults (59% had T2DM) | a) Retrospective cohort | a) The Recalibrated Pooled KFRE SEA has similar discrimination with slightly improved precision. | Original KFRE: |
b) Primary care CKD population | b) Validation | a) 4-variable 2-year score: 0.96 (0.95–0.97) | ||
c) 89% CKD stage 3 | c) Recalibration in Singapore population | b) The effect of competing mortality risk is unlikely to affect the ESKD prediction. | b) 4-variable 5-year score: 0.94 (0.93–0.95) | |
d) Urinary ACR data not included | d) Clinical utility | Recalibrated Pooled KFRE SEA: | ||
e) Mean±SD age: 75±9 years | c) Using calculated 5-year risk >10%–16% to guide dialysis planning and calculated 2-year risk >45% to guide nephrologist referral would facilitate more efficient care and accurate risk stratification. | a) 4-variable 2-year score: 0.96 (0.95–0.97) | ||
f) Men 49% | b) 4-variable 5-year score: 0.94 (0.93–0.95) | |||
Tangri et al. (2020) [64]; Canada | a) 3,659 kidney transplant recipients | a) Retrospective cohort | a) Accurately predicts graft failure in kidney transplant recipients with even better discrimination when eGFR is <45 mL/min/1.73 m2 (death was not treated as a competing risk). | a) 4-variable 2-year score: 0.81 (0.72–0.91) |
b) Transplant database from multiple transplant centers in Canada | b) Validation among kidney transplant recipients 1 year post-transplant | |||
c) 26% had eGFR <45 mL/min/1.73 m2 | b) 4-variable 5-year score: 0.73 (0.67–0.80) | |||
d) Median urinary ACR: 2.2–9.8 mg/mmol across 4 cohorts | ||||
e) Mean age: 47–53 years across 4 cohorts | ||||
f) Men 60%–66% across 4 cohorts | ||||
Kang et al. (2020) [65]; Korea | a) 13,244 adults (29% had diabetes) | a) Retrospective cohort | a) 28.0% subjects developed ESKD during the mean follow-up period of 4.1 years. | a) 4-variable 2-year score: 0.86 (0.86–0.87) |
b) Nephrology clinic in 2 tertiary centers | b) Validation in Korean population and recalibration | b) 6-variable 2-year score: 0.87 (0.86–0.88) | ||
c) Mean±SD eGFR: 36.1±17.1 mL/min/1.73 m2 | b) Excellent discrimination | c) 8-variable 2-year score: 0.88 (0.86–0.88) | ||
d) Mean±SD urinary ACR: 992.9±2,325.6 mg/g | c) No need for recalibration | d) 4-variable 5-year score: 0.83 (0.82–0.85) | ||
e) Mean±SD age: 60±14 years | e) 6-variable 5-year score: 0.83 (0.82–0.84) | |||
f) Men 58% | f) 8-variable 5-year score: 0.83 (0.82–0.85) | |||
Chu et al. (2020) [66]; USA | a) 2,889 kidney transplant recipients (43% living donor graft, 39.3% had diabetes) | a) Retrospective cohort | a) 2.4% developed graft loss by 2 years, 8.7% by 5 years | a) 4-variable 2-year score: 0.85 (0.81–0.88) |
b) Multi-center cohort-majority from the USA, few from Canada and Brazil | b) Validation among kidney transplant recipients with eGFR ≤60 mL/min/1.73 m2 6 months post-transplant | b) Accurate calibration and discrimination (death treated as a competing risk) | b) 4-variable 5-year score: 0.81 (0.78–0.84) | |
c) Mean±SD eGFR: 41±11 mL/min/1.73 m2 | c) Well calibrated for both deceased donor and living donor grafts | |||
d) Median urinary ACR 28 mg/g (IQR, 10–119) | d) Poor calibration for subgroups of less than 2 years post-transplantation | |||
e) Mean±SD age: 52±9 years | ||||
f) Men 61% | ||||
Hundemer et al. (2020) [67]; Canada | a) 1,293 adults (49% had diabetes) | a) Retrospective cohort | a) Excellent discrimination & adequate calibra-tion across CKD etiologies (death was not treated as a competing risk) | a) 4-variable 2-year score: 0.83 (0.81–0.85) |
b) Specialty nephrology clinic at single academic tertiary center | b) Validation across different CKD etiologies | |||
c) Median eGFR: 15 mL/min/1.73 m2 (IQR, 12–19) | b) Underestimation of risk for ADPKD subgroup | b) 4-variable 2-year score: 0.81 (0.77–0.84) | ||
d) Median urinary ACR: 1,277 mg/g (IQR, 322–2,903) | ||||
e) Median age: 68 years (IQR, 58–78) | ||||
f) Men 61% | ||||
Ali et al. (2021) [68]; United Kingdom | a) 743 adults (40% had diabetes) | a) Retrospective cohort | a) Good discrimination with similar predictive accuracy | a) 4- and 8-variable 2-year score: 0.79 (0.76–0.83) |
b) Advanced kidney care service clinic at single tertiary care center | b) Validation & clinical utility across different etiologies of CKD | b) Underestimation of risk for ADPKD subgroup | ||
c) Median eGFR: 16 mL/min/1.73 m2 (IQR, 13–18) | d) Better for guiding further intervention compared to using eGFR cut-offs | b) 4- and 8-variable 5-year score: 0.77 (0.74–0.81) | ||
d) Median urinary ACR: 409 mg/g (IQR, 85–1,356) | ||||
e) Median age: 69 years (IQR, 57–77) | ||||
f) Men 62% | ||||
Ramspek et al. (2021) [38]; Europe | a) 15,069 adults (21% had diabetes) | a) Retrospective cohorts | a) Excellent calibration and good discrimination | EQUAL cohort |
b) Multi-center cohorts | b) Validation | b) 5-year KFRE overpredicted risk by 10%–18% (death as competing risk) | a) 4-variable 2-year score: 0.76 (0.72–0.80) | |
c) Mean±SD eGFR: (EQUAL cohort) 18.5±4.7 mL/min/1.73 m2 (SRR cohort) 21.9±5.7 mL/min/1.73 m2 | b) 8-variable 2-year score: 0.78 (0.75–0.81) | |||
c) 4-variable 5-year score: 0.75 (0.71–0.78) | ||||
d) Median urinary ACR: (EQUAL cohort) 40 mg/mmol (IQR, 8–165) (SRR cohort) 36 mg/mmol (IQR, 7–155) | d) 8-variable 5-year score: 0.76 (0.73–0.79) | |||
SRS cohort | ||||
e) Mean age: 74–76 years across 2 cohorts | a) 4- and 8-variable 2-year score: 0.84 (0.83–0.85) | |||
f) Men 61%–65% | b) 4- and 8-variable 5-year score: 0.81 (0.80–0.82) | |||
Ali (2021) [69]; United Kingdom | a) 415 transplant recipients (18.9% living donor graft, 12% had diabetes) | a) Retrospective cohort | a) Adequate discrimination for predicting graft failure, especially in those with an eGFR <45 mL/min/1.73 m2 with poor calibration (likely due to lack of transplant related variables) | a) 4-variable 5-year score: 0.74 (0.61–0.88) |
b) Single renal transplant center | b) Validation among kidney transplant recipients 1-year post-transplant | b) 8-variable 5-year score: 0.75 (0.63–0.87) | ||
c) Median eGFR: 54.1 mL/min/1.73 m2 (IQR, 41.6–70.5) | ||||
d) Median urinary ACR: 22.1 mg/g (IQR, 11.5–65.4) | ||||
e) Median age: 50 years (IQR, 40–60) | ||||
f) Men 59% | ||||
Kwek et al. (2022) [70]; Singapore | a) 1,128 adults (64.6% had diabetes) | a) Retrospective cohort | a) Excellent discrimination (death not taken as a competing risk) | a) 4-variable 2-year score: 0.87 (0.85–0.90) |
b) Nephrology clinic, single tertiary center | b) Validation | b) 8-variable 2-year score: 0.87 (0.85–0.89) | ||
c) Median eGFR: 31.9 mL/min/1.73 m2 (IQR, 22.4–44.8) | ||||
d) Median urinary ACR: 243 mg/g (range, 63–868) | ||||
e) Mean±SD age: 67±12 years | ||||
f) Men 58% | ||||
Irish et al. (2023) [71]; Australia | a) 12,861 adults (54.9% had diabetes) | a) Retrospective cohort | a) Excellent discrimination and adequately calibrated (death not taken as a competing risk) | a) 4-variable 2-year score: 0.98 (0.97–0.99) |
b) Multiple national registries | b) Validation among Australian cohort | b) 6-variable 2-year score: 0.97 (0.96–0.99) | ||
c) Mean±SD eGFR: 50.3±9.3 mL/min/1.73 m2 | c) 8-variable 2-year score: 0.96 (0.94–0.98) | |||
d) Median urinary ACR: 1.4 mg/g (IQR, 0.6–5.0) | d) 4-variable 5-year score: 0.96 (0.95–0.97) | |||
e) Mean±SD age: 70±10 years | e) 6-variable 5-year score: 0.96 (0.95–0.97) | |||
f) Men 48% | f) 8-variable 5-year score: 0.95 (0.93–0.96) |
KFRE, Kidney Failure Risk Equation; CI, confidence interval; SD, standard deviation; eGFR, estimated glomerular filtration rate; ACR, albumin-creatinine ratio; IQR, interquartile range; RRI, renal resistive index; DI-RISK, difference of resistive indices in spleen and kidney; CKD, chronic kidney disease; MREK, mortality risk equation for kidney disease; RRT, renal replacement therapy; T2DM, type 2 diabetes mellitus; SEA, South East Asia; ESKD, end-stage kidney disease; ADPKD, autosomal dominant polycystic kidney disease; EQUAL, European Quality Study; SRR, Swedish Renal Registry.
Study; Region | Study characteristics | Study design and aim | Key findings | KFRE, C statistic (95% CI) |
---|---|---|---|---|
Tangri et al. (2016) [59]; North America & Europe | a) 721,357 adults (40% had diabetes) | a) Meta-analysis | a) Excellent discrimination and appropriate cali-bration (death not treated as competing risk) | a) 4- and 8-variable 2-year score: 0.90 (0.89–0.92) |
b) Multinational cohorts from Chronic Kidney Disease Prognosis Consortium (CKD-PC) | b) Validation and recalibration for non-USA/Canada cohorts | |||
c) Mean±SD eGFR: 46±11 mL/min/1.73 m2 | b) Addition of a recalibration factor optimized performance in non-USA/Canada populations | b) 4- and 8-variable 5-year: 0.88 (0.86–0.90) | ||
d) 40% has baseline urinary ACR of ≥30 mg/g | ||||
e) Mean±SD age: 74±10 years | ||||
f) Men 77% | ||||
Lennartz et al. (2016) [60]; Germany | a) 403 adults | a) Prospective cohorts | a) Excellent discrimination and calibration | a) 4-variable 3-year score: 0.91 (0.83–0.99) |
b) Referral to tertiary nephrology care center | b) Validation | b) Addition of ultrasound markers did not improve performance | ||
c) Mean±SD eGFR: 55.7±32 mL/min/1.73 m2 | c) Addition of ultrasound markers: RRI or DI-RISK | |||
d) Median urinary ACR: 44 mg/g (IQR, 15–204) | ||||
e) Mean±SD age: 60±15 years | ||||
f) Men 58% | ||||
g) Mean±SD RRI: 72±9 | ||||
h) Mean±SD DI-RISK: 8±5 | ||||
Major et al. (2019) [61]; United Kingdom | a) 35,539 adults (31.5% had diabetes) | a) Retrospective cohort | a) Excellent discrimination (death not treated as competing risk) | a) 4-variable 2-year score: 0.93 (0.91–0.96) |
b) Primary care CKD population | b) Validation in primary care setting and clinical utility | |||
c) Median eGFR: 51 mL/min/1.73 m2 (IQR, 43–56) | b) Referral criteria based on 5-year risk of ≥5% and/or an urinary ACR of ≥70 mg/mmol is time and cost-effective | b) 4-variable 5-year score: 0.93 (0.91–0.94) | ||
d) Median urinary ACR: 3.2 mg/mmol (IQR, 1.2–8.0) | ||||
e) Mean±SD age: 76±10 years | ||||
f) Men 43% | ||||
Hallan et al. (2019) [62]; USA | a) 1,188 elderly (17% had diabetes) | a) Retrospective cohort | a) Well calibrated with excellent discrimination | a) 4-variable 5-year score: 0.88 (0.86–0.90) |
b) General population-based data | b) Validation of both KFRE and MREK in elderly | b) Recommend using both MREK and KFRE to decide whether to prepare for RRT in elderly people with advanced CKD | ||
c) Mean±SD eGFR: 36±8 mL/min/1.73 m2 | ||||
d) Mean±SD urinary ACR: 7.1±18.7 mg/mmol | ||||
e) Mean±SD age: 80±6.8 years | ||||
f) Men 47% | ||||
Wang et al. (2019) [63]; Singapore | a) 17,271 adults (59% had T2DM) | a) Retrospective cohort | a) The Recalibrated Pooled KFRE SEA has similar discrimination with slightly improved precision. | Original KFRE: |
b) Primary care CKD population | b) Validation | a) 4-variable 2-year score: 0.96 (0.95–0.97) | ||
c) 89% CKD stage 3 | c) Recalibration in Singapore population | b) The effect of competing mortality risk is unlikely to affect the ESKD prediction. | b) 4-variable 5-year score: 0.94 (0.93–0.95) | |
d) Urinary ACR data not included | d) Clinical utility | Recalibrated Pooled KFRE SEA: | ||
e) Mean±SD age: 75±9 years | c) Using calculated 5-year risk >10%–16% to guide dialysis planning and calculated 2-year risk >45% to guide nephrologist referral would facilitate more efficient care and accurate risk stratification. | a) 4-variable 2-year score: 0.96 (0.95–0.97) | ||
f) Men 49% | b) 4-variable 5-year score: 0.94 (0.93–0.95) | |||
Tangri et al. (2020) [64]; Canada | a) 3,659 kidney transplant recipients | a) Retrospective cohort | a) Accurately predicts graft failure in kidney transplant recipients with even better discrimination when eGFR is <45 mL/min/1.73 m2 (death was not treated as a competing risk). | a) 4-variable 2-year score: 0.81 (0.72–0.91) |
b) Transplant database from multiple transplant centers in Canada | b) Validation among kidney transplant recipients 1 year post-transplant | |||
c) 26% had eGFR <45 mL/min/1.73 m2 | b) 4-variable 5-year score: 0.73 (0.67–0.80) | |||
d) Median urinary ACR: 2.2–9.8 mg/mmol across 4 cohorts | ||||
e) Mean age: 47–53 years across 4 cohorts | ||||
f) Men 60%–66% across 4 cohorts | ||||
Kang et al. (2020) [65]; Korea | a) 13,244 adults (29% had diabetes) | a) Retrospective cohort | a) 28.0% subjects developed ESKD during the mean follow-up period of 4.1 years. | a) 4-variable 2-year score: 0.86 (0.86–0.87) |
b) Nephrology clinic in 2 tertiary centers | b) Validation in Korean population and recalibration | b) 6-variable 2-year score: 0.87 (0.86–0.88) | ||
c) Mean±SD eGFR: 36.1±17.1 mL/min/1.73 m2 | b) Excellent discrimination | c) 8-variable 2-year score: 0.88 (0.86–0.88) | ||
d) Mean±SD urinary ACR: 992.9±2,325.6 mg/g | c) No need for recalibration | d) 4-variable 5-year score: 0.83 (0.82–0.85) | ||
e) Mean±SD age: 60±14 years | e) 6-variable 5-year score: 0.83 (0.82–0.84) | |||
f) Men 58% | f) 8-variable 5-year score: 0.83 (0.82–0.85) | |||
Chu et al. (2020) [66]; USA | a) 2,889 kidney transplant recipients (43% living donor graft, 39.3% had diabetes) | a) Retrospective cohort | a) 2.4% developed graft loss by 2 years, 8.7% by 5 years | a) 4-variable 2-year score: 0.85 (0.81–0.88) |
b) Multi-center cohort-majority from the USA, few from Canada and Brazil | b) Validation among kidney transplant recipients with eGFR ≤60 mL/min/1.73 m2 6 months post-transplant | b) Accurate calibration and discrimination (death treated as a competing risk) | b) 4-variable 5-year score: 0.81 (0.78–0.84) | |
c) Mean±SD eGFR: 41±11 mL/min/1.73 m2 | c) Well calibrated for both deceased donor and living donor grafts | |||
d) Median urinary ACR 28 mg/g (IQR, 10–119) | d) Poor calibration for subgroups of less than 2 years post-transplantation | |||
e) Mean±SD age: 52±9 years | ||||
f) Men 61% | ||||
Hundemer et al. (2020) [67]; Canada | a) 1,293 adults (49% had diabetes) | a) Retrospective cohort | a) Excellent discrimination & adequate calibra-tion across CKD etiologies (death was not treated as a competing risk) | a) 4-variable 2-year score: 0.83 (0.81–0.85) |
b) Specialty nephrology clinic at single academic tertiary center | b) Validation across different CKD etiologies | |||
c) Median eGFR: 15 mL/min/1.73 m2 (IQR, 12–19) | b) Underestimation of risk for ADPKD subgroup | b) 4-variable 2-year score: 0.81 (0.77–0.84) | ||
d) Median urinary ACR: 1,277 mg/g (IQR, 322–2,903) | ||||
e) Median age: 68 years (IQR, 58–78) | ||||
f) Men 61% | ||||
Ali et al. (2021) [68]; United Kingdom | a) 743 adults (40% had diabetes) | a) Retrospective cohort | a) Good discrimination with similar predictive accuracy | a) 4- and 8-variable 2-year score: 0.79 (0.76–0.83) |
b) Advanced kidney care service clinic at single tertiary care center | b) Validation & clinical utility across different etiologies of CKD | b) Underestimation of risk for ADPKD subgroup | ||
c) Median eGFR: 16 mL/min/1.73 m2 (IQR, 13–18) | d) Better for guiding further intervention compared to using eGFR cut-offs | b) 4- and 8-variable 5-year score: 0.77 (0.74–0.81) | ||
d) Median urinary ACR: 409 mg/g (IQR, 85–1,356) | ||||
e) Median age: 69 years (IQR, 57–77) | ||||
f) Men 62% | ||||
Ramspek et al. (2021) [38]; Europe | a) 15,069 adults (21% had diabetes) | a) Retrospective cohorts | a) Excellent calibration and good discrimination | EQUAL cohort |
b) Multi-center cohorts | b) Validation | b) 5-year KFRE overpredicted risk by 10%–18% (death as competing risk) | a) 4-variable 2-year score: 0.76 (0.72–0.80) | |
c) Mean±SD eGFR: (EQUAL cohort) 18.5±4.7 mL/min/1.73 m2 (SRR cohort) 21.9±5.7 mL/min/1.73 m2 | b) 8-variable 2-year score: 0.78 (0.75–0.81) | |||
c) 4-variable 5-year score: 0.75 (0.71–0.78) | ||||
d) Median urinary ACR: (EQUAL cohort) 40 mg/mmol (IQR, 8–165) (SRR cohort) 36 mg/mmol (IQR, 7–155) | d) 8-variable 5-year score: 0.76 (0.73–0.79) | |||
SRS cohort | ||||
e) Mean age: 74–76 years across 2 cohorts | a) 4- and 8-variable 2-year score: 0.84 (0.83–0.85) | |||
f) Men 61%–65% | b) 4- and 8-variable 5-year score: 0.81 (0.80–0.82) | |||
Ali (2021) [69]; United Kingdom | a) 415 transplant recipients (18.9% living donor graft, 12% had diabetes) | a) Retrospective cohort | a) Adequate discrimination for predicting graft failure, especially in those with an eGFR <45 mL/min/1.73 m2 with poor calibration (likely due to lack of transplant related variables) | a) 4-variable 5-year score: 0.74 (0.61–0.88) |
b) Single renal transplant center | b) Validation among kidney transplant recipients 1-year post-transplant | b) 8-variable 5-year score: 0.75 (0.63–0.87) | ||
c) Median eGFR: 54.1 mL/min/1.73 m2 (IQR, 41.6–70.5) | ||||
d) Median urinary ACR: 22.1 mg/g (IQR, 11.5–65.4) | ||||
e) Median age: 50 years (IQR, 40–60) | ||||
f) Men 59% | ||||
Kwek et al. (2022) [70]; Singapore | a) 1,128 adults (64.6% had diabetes) | a) Retrospective cohort | a) Excellent discrimination (death not taken as a competing risk) | a) 4-variable 2-year score: 0.87 (0.85–0.90) |
b) Nephrology clinic, single tertiary center | b) Validation | b) 8-variable 2-year score: 0.87 (0.85–0.89) | ||
c) Median eGFR: 31.9 mL/min/1.73 m2 (IQR, 22.4–44.8) | ||||
d) Median urinary ACR: 243 mg/g (range, 63–868) | ||||
e) Mean±SD age: 67±12 years | ||||
f) Men 58% | ||||
Irish et al. (2023) [71]; Australia | a) 12,861 adults (54.9% had diabetes) | a) Retrospective cohort | a) Excellent discrimination and adequately calibrated (death not taken as a competing risk) | a) 4-variable 2-year score: 0.98 (0.97–0.99) |
b) Multiple national registries | b) Validation among Australian cohort | b) 6-variable 2-year score: 0.97 (0.96–0.99) | ||
c) Mean±SD eGFR: 50.3±9.3 mL/min/1.73 m2 | c) 8-variable 2-year score: 0.96 (0.94–0.98) | |||
d) Median urinary ACR: 1.4 mg/g (IQR, 0.6–5.0) | d) 4-variable 5-year score: 0.96 (0.95–0.97) | |||
e) Mean±SD age: 70±10 years | e) 6-variable 5-year score: 0.96 (0.95–0.97) | |||
f) Men 48% | f) 8-variable 5-year score: 0.95 (0.93–0.96) |
KFRE, Kidney Failure Risk Equation; CI, confidence interval; SD, standard deviation; eGFR, estimated glomerular filtration rate; ACR, albumin-creatinine ratio; IQR, interquartile range; RRI, renal resistive index; DI-RISK, difference of resistive indices in spleen and kidney; CKD, chronic kidney disease; MREK, mortality risk equation for kidney disease; RRT, renal replacement therapy; T2DM, type 2 diabetes mellitus; SEA, South East Asia; ESKD, end-stage kidney disease; ADPKD, autosomal dominant polycystic kidney disease; EQUAL, European Quality Study; SRR, Swedish Renal Registry.