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Evaluating risk of ESRD in the urban poor

Maziarz, Marlena LU ; Black, R. Anthony ; Fong, Christine T. ; Himmelfarb, Jonathan ; Chertow, Glenn M. and Hall, Yoshio N. (2015) In Journal of the American Society of Nephrology 26(6). p.1434-1442
Abstract

The capacity of risk prediction to guide management of CKD in underserved health settings is unknown. We conducted a retrospective cohort study of 28,779 adults with nondialysis-requiring CKD who received health care in two large safety net health systems during 1996-2009 and were followed for ESRD through September of 2011. We developed and evaluated the performance of ESRD risk prediction models using recently proposed criteria designed to inform population health approaches to disease management: proportion of cases followed and proportion that needs to be followed. Overall, 1730 persons progressed to ESRD during follow-up (median follow-up=6.6 years). ESRD risk for time frames up to 5 years was highly concentrated among relatively... (More)

The capacity of risk prediction to guide management of CKD in underserved health settings is unknown. We conducted a retrospective cohort study of 28,779 adults with nondialysis-requiring CKD who received health care in two large safety net health systems during 1996-2009 and were followed for ESRD through September of 2011. We developed and evaluated the performance of ESRD risk prediction models using recently proposed criteria designed to inform population health approaches to disease management: proportion of cases followed and proportion that needs to be followed. Overall, 1730 persons progressed to ESRD during follow-up (median follow-up=6.6 years). ESRD risk for time frames up to 5 years was highly concentrated among relatively few individuals. A predictive model using five common variables (age, sex, race, eGFR, and dipstick proteinuria) performed similarly to more complex models incorporating extensive sociodemographic and clinical data. Using this model, 80% of individuals who eventually developed ESRD were among the 5% of cohort members at the highest estimated risk for ESRD at 1 year. Similarly, a program that followed 8% and 13% of individuals at the highest ESRD risk would have included 80% of those who eventually progressed to ESRD at 3 and 5 years, respectively. In this underserved health setting, a simple five-variable model accurately predicts most cases of ESRD that develop within 5 years. Applying risk prediction using a population health approach may improve CKD surveillance and management of vulnerable groups by directing resources to a small subpopulation at highest risk for progressing to ESRD.

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publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the American Society of Nephrology
volume
26
issue
6
pages
9 pages
publisher
American Society of Nephrology
external identifiers
  • scopus:84930467356
  • pmid:25475746
ISSN
1046-6673
DOI
10.1681/ASN.2014060546
language
English
LU publication?
no
id
0657441d-8c25-436c-90f9-e0409ce0ecf9
date added to LUP
2019-08-05 11:56:44
date last changed
2024-06-11 22:44:43
@article{0657441d-8c25-436c-90f9-e0409ce0ecf9,
  abstract     = {{<p>The capacity of risk prediction to guide management of CKD in underserved health settings is unknown. We conducted a retrospective cohort study of 28,779 adults with nondialysis-requiring CKD who received health care in two large safety net health systems during 1996-2009 and were followed for ESRD through September of 2011. We developed and evaluated the performance of ESRD risk prediction models using recently proposed criteria designed to inform population health approaches to disease management: proportion of cases followed and proportion that needs to be followed. Overall, 1730 persons progressed to ESRD during follow-up (median follow-up=6.6 years). ESRD risk for time frames up to 5 years was highly concentrated among relatively few individuals. A predictive model using five common variables (age, sex, race, eGFR, and dipstick proteinuria) performed similarly to more complex models incorporating extensive sociodemographic and clinical data. Using this model, 80% of individuals who eventually developed ESRD were among the 5% of cohort members at the highest estimated risk for ESRD at 1 year. Similarly, a program that followed 8% and 13% of individuals at the highest ESRD risk would have included 80% of those who eventually progressed to ESRD at 3 and 5 years, respectively. In this underserved health setting, a simple five-variable model accurately predicts most cases of ESRD that develop within 5 years. Applying risk prediction using a population health approach may improve CKD surveillance and management of vulnerable groups by directing resources to a small subpopulation at highest risk for progressing to ESRD.</p>}},
  author       = {{Maziarz, Marlena and Black, R. Anthony and Fong, Christine T. and Himmelfarb, Jonathan and Chertow, Glenn M. and Hall, Yoshio N.}},
  issn         = {{1046-6673}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{1434--1442}},
  publisher    = {{American Society of Nephrology}},
  series       = {{Journal of the American Society of Nephrology}},
  title        = {{Evaluating risk of ESRD in the urban poor}},
  url          = {{http://dx.doi.org/10.1681/ASN.2014060546}},
  doi          = {{10.1681/ASN.2014060546}},
  volume       = {{26}},
  year         = {{2015}},
}