Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

365noBackground and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p < 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p < 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely.nonenoneNordio M.; Reboldi G.; Di Napoli A.; Quintaliani G.; Alberici F.; Postorino M.; Aucella F.; Messa P.; Brunori G.; Brunori G.; Bosco M.; Malberti F.; Mandreoli M.; Mazzaferro S.; Movilli E.; Ravera M.; Salomone M.; Santoro D.; PostorinoLimido M.A.; Bonomini M.; Stingone A.; Maccarone M.; Di Loreto E.; Stacchiotti L.; Malandra R.; Chiarella S.; D'Agostino F.; Fuiano G.; Nicodemo L.; Bonofiglio R.; Greco S.; Mallamaci F.; Barreca E.; Caserta C.; Bruzzese V.; Galati D.; Tramontana D.; Viscione M.; Chiuchiolo L.; Tuccillo S.; Sepe M.; Vitale F.; Ciriana E.; Santoro D.; Martignetti V.; Caserta D.; Stizzo A.; Romano A.; Iulianiello G.; Cascone E.; Minicone P.; Chiricone D.; Delgado G.; Barbato A.; Celentano S.; Molfino I.; Coppola S.; Raiola I.; Abategiovanni M.; Borrelli S.; Margherita C.; Bruno F.; Ida M.; Aliperti E.; Potito D.; Cuomo G.; De Luca M.; Merola M.; Botta C.; Garofalo G.; Alinei P.; Paglionico C.; Roano M.; Vitale S.; Ierardi R.; Fimiani V.; Conte G.; Di Natale G.; Romano M.; Di Marino V.; Scafarto A.; Meccariello S.; Pecoraro C.; Di Stazio E.; Di Meglio E.; Cuomo A.; Maresca B.; Rotaia E.; Capasso G.; Auricchio M.; Pluvio C.; Maddalena L.; De Maio A.; Palladino G.; Buono F.; Gigliotti G.; Mandreoli M.; Mancini E.; La Manna G.; Storari A.; Mosconi G.; Cappelli G.; Scarpioni R.; Gregorini M.; Rigotti A.; Mancini W.; Bianco F.; Boscutti G.; Amici G.; Tosto M.; Fini R.; Pace G.; Cioffi A.; Boccia E.; Di Lullo L.; Di Zazzo G.; Simonelli R.; Bondatti F.; Miglio L.; Rifici N.; Treglia A.; Muci M.; Baldinelli G.; Rizzi E.; Lonzi M.; De Cicco C.; Forte F.; De Paolis P.; Grandaliano G.; Cuzziol C.; Torre V.M.; Sfregola P.; Rossi V.; Fabio G.; Flammini A.; Filippini A.; Onorato L.; Vendola F.; Di Daniela N.; Alfarone C.; Scabbia L.; Ferrazzano M.; Grotta B.D.; Gamberini M.; Fazzari L.; Mene P.; Morgia A.; Catucci A.; Palumbo R.; Puliti M.; Marinelli R.; Polito P.; Marrocco F.; Morabito S.; Rocca R.; Nazzaro L.; Lavini R.; Iamundo V.; Chiappini M.; Casarci M.; Morosetti M.; Hassan S.; Alfarone C.; Ferrazzano M.; Firmi G.; Galliani M.; Serraiocco M.; Feriozzi S.; Valentini W.; Sacco P.; Garibotto G.; Cappelli V.; Saffioti C.; Repetto M.; Rolla D.; Lorenz M.; Pedrini L.; Polonioli D.; Galli E.; Ruggenenti P.; Scolari F.; Bove S.; Costantino E.; Bracchi M.; Mangano S.; Depetri G.; Malberti F.; La Milia V.; Farina M.; Zecchini S.; Savino R.; Melandri M.; Guastoni C.; Paparella M.; Gallieni M.; Minetti E.; Bisegna S.; Messa P.; Righetti M.; Badalamenti S.; Guastoni C.; Alberghini E.; Bertoli S.; Fabbrini P.; Albrizio P.; Rampino T.; Colturi C.; Rombola G.; Lucatello A.; Guerrini E.; Ranghino A.; Lenci F.; Fanciulli E.; Santarelli S.; Damiani C.; Garofalo D.; Sopranzi F.; Santoferrara A.; Di Luca M.; Galiotta P.; Brigante M.; Manganaro M.; Maffei S.; Berto I.; Besso L.; Viglino G.; Besso L.; Cusinato S.; ChiarinottiChiappero D.F.; Tognarelli G.; Gianoglio B.; Salomone M.; Forneris G.; Biancone L.; Savoldi S.; Vitale C.; Boero R.; Filiberti O.; Borzumati M.; Gesualdo L.; Lomonte C.; Gernone G.; Pallotta G.; Di Paolo S.; Vernaglione L.; Specchio A.; Stallone G.; Dell'Aquila R.; Aucella F.; Sandri G.; Russo F.; Napoli M.; Marangi A.; Morrone L.; Di Stratis C.; Fresu A.; Cicu F.; Murtas S.; Manca O.; Pani A.; Pilloni M.; Pistis R.; Cadoni M.; Contu B.; Logias F.; Ivaldi R.; Fancello S.; Cossu M.; Lepori G.; Lepori G.; Vittoria S.; Battiati E.; Arnone M.; Rome M.; Barbera A.; Granata A.; Collura G.; Dico C.L.; Pugliese G.; Di Natale E.; Rizzari G.; Cottone L.; Longo N.; Battaglia G.; Marcantoni C.; Giannetto G.; Tumino G.; Randazzo F.; Bellissimo L.; Faro F.L.; Grippaldi F.; Urso S.; Quattrone G.; Todaro I.; Vincenzo D.; Murgo A.; Masuzzo M.; Pisacane A.; Monardo P.; Santoro D.; Pontorierro M.; Quari C.; Bauro A.; Chimenz R.R.; Alfio D.; Girasole F.; Cascio A.L.; Caviglia A.; Tornese F.; Sirna F.; Altieri C.; Cusumano R.; Saveriano V.; La Corte A.; Locascio G.; Rotolo U.; Rome M.; Musso S.; Risuglia L.; Blanco G.; Minardo G.; Castellino S.; Zappulla Z.; Randone S.; Di Francesca M.; Cassetti C.C.; Oddo G.; Buscaino G.; Mucaria F.; Barraco V.I.; Di Martino A.; Mucaria F.; Rallo D.; Dani L.; Campolo G.; Manescalchi F.; Biagini M.; Agate M.; Panichi V.; Casani A.; Traversari L.; Garosi G.; Brunori G.; Tabbi M.; Selvi A.; Cencioni L.; Fagugli R.; Timio F.; Leveque A.; Manes M.; Mennella G.; Calo L.; Fiorini F.; Abaterusso C.; Calzavara P.; Nordio M.; Meneghel G.; Bonesso C.; Gambaro G.; Gammaro L.; Rugiu C.; Dell'Aquila R.; Dell'Aquila R.; Ronco C.; Rugiu C.Nordio, M.; Reboldi, G.; Di Napoli, A.; Quintaliani, G.; Alberici, F.; Postorino, M.; Aucella, F.; Messa, P.; Brunori, G.; Brunori, G.; Bosco, M.; Malberti, F.; Mandreoli, M.; Mazzaferro, S.; Movilli, E.; Ravera, M.; Salomone, M.; Santoro, D.; Postorinolimido, M. A.; Bonomini, M.; Stingone, A.; Maccarone, M.; Di Loreto, E.; Stacchiotti, L.; Malandra, R.; Chiarella, S.; D'Agostino, F.; Fuiano, G.; Nicodemo, L.; Bonofiglio, R.; Greco, S.; Mallamaci, F.; Barreca, E.; Caserta, C.; Bruzzese, V.; Galati, D.; Tramontana, D.; Viscione, M.; Chiuchiolo, L.; Tuccillo, S.; Sepe, M.; Vitale, F.; Ciriana, E.; Santoro, D.; Martignetti, V.; Caserta, D.; Stizzo, A.; Romano, A.; Iulianiello, G.; Cascone, E.; Minicone, P.; Chiricone, D.; Delgado, G.; Barbato, A.; Celentano, S.; Molfino, I.; Coppola, S.; Raiola, I.; Abategiovanni, M.; Borrelli, S.; Margherita, C.; Bruno, F.; Ida, M.; Aliperti, E.; Potito, D.; Cuomo, G.; De Luca, M.; Merola, M.; Botta, C.; Garofalo, G.; Alinei, P.; Paglionico, C.; Roano, M.; Vitale, S.; Ierardi, R.; Fimiani, V.; Conte, G.; Di Natale, G.; Romano, M.; Di Marino, V.; Scafarto, A.; Meccariello, S.; Pecoraro, C.; Di Stazio, E.; Di Meglio, E.; Cuomo, A.; Maresca, B.; Rotaia, E.; Capasso, G.; Auricchio, M.; Pluvio, C.; Maddalena, L.; De Maio, A.; Palladino, G.; Buono, F.; Gigliotti, G.; Mandreoli, M.; Mancini, E.; La Manna, G.; Storari, A.; Mosconi, G.; Cappelli, G.; Scarpioni, R.; Gregorini, M.; Rigotti, A.; Mancini, W.; Bianco, F.; Boscutti, G.; Amici, G.; Tosto, M.; Fini, R.; Pace, G.; Cioffi, A.; Boccia, E.; Di Lullo, L.; Di Zazzo, G.; Simonelli, R.; Bondatti, F.; Miglio, L.; Rifici, N.; Treglia, A.; Muci, M.; Baldinelli, G.; Rizzi, E.; Lonzi, M.; De Cicco, C.; Forte, F.; De Paolis, P.; Grandaliano, G.; Cuzziol, C.; Torre, V. M.; Sfregola, P.; Rossi, V.; Fabio, G.; Flammini, A.; Filippini, A.; Onorato, L.; Vendola, F.; Di Daniela, N.; Alfarone, C.; Scabbia, L.; Ferrazzano, M.; Grotta, B. D.; Gamberini, M.; Fazzari, L.; Mene, P.; Morgia, A.; Catucci, A.; Palumbo, R.; Puliti, M.; Marinelli, R.; Polito, P.; Marrocco, F.; Morabito, S.; Rocca, R.; Nazzaro, L.; Lavini, R.; Iamundo, V.; Chiappini, M.; Casarci, M.; Morosetti, M.; Hassan, S.; Alfarone, C.; Ferrazzano, M.; Firmi, G.; Galliani, M.; Serraiocco, M.; Feriozzi, S.; Valentini, W.; Sacco, P.; Garibotto, G.; Cappelli, V.; Saffioti, C.; Repetto, M.; Rolla, D.; Lorenz, M.; Pedrini, L.; Polonioli, D.; Galli, E.; Ruggenenti, P.; Scolari, F.; Bove, S.; Costantino, E.; Bracchi, M.; Mangano, S.; Depetri, G.; Malberti, F.; La Milia, V.; Farina, M.; Zecchini, S.; Savino, R.; Melandri, M.; Guastoni, C.; Paparella, M.; Gallieni, M.; Minetti, E.; Bisegna, S.; Messa, P.; Righetti, M.; Badalamenti, S.; Guastoni, C.; Alberghini, E.; Bertoli, S.; Fabbrini, P.; Albrizio, P.; Rampino, T.; Colturi, C.; Rombola, G.; Lucatello, A.; Guerrini, E.; Ranghino, A.; Lenci, F.; Fanciulli, E.; Santarelli, S.; Damiani, C.; Garofalo, D.; Sopranzi, F.; Santoferrara, A.; Di Luca, M.; Galiotta, P.; Brigante, M.; Manganaro, M.; Maffei, S.; Berto, I.; Besso, L.; Viglino, G.; Besso, L.; Cusinato, S.; Chiarinottichiappero, D. F.; Tognarelli, G.; Gianoglio, B.; Salomone, M.; Forneris, G.; Biancone, L.; Savoldi, S.; Vitale, C.; Boero, R.; Filiberti, O.; Borzumati, M.; Gesualdo, L.; Lomonte, C.; Gernone, G.; Pallotta, G.; Di Paolo, S.; Vernaglione, L.; Specchio, A.; Stallone, G.; Dell'Aquila, R.; Aucella, F.; Sandri, G.; Russo, F.; Napoli, M.; Marangi, A.; Morrone, L.; Di Stratis, C.; Fresu, A.; Cicu, F.; Murtas, S.; Manca, O.; Pani, A.; Pilloni, M.; Pistis, R.; Cadoni, M.; Contu, B.; Logias, F.; Ivaldi, R.; Fancello, S.; Cossu, M.; Lepori, G.; Lepori, G.; Vittoria, S.; Battiati, E.; Arnone, M.; Rome, M.; Barbera, A.; Granata, A.; Collura, G.; Dico, C. L.; Pugliese, G.; Di Natale, E.; Rizzari, G.; Cottone, L.; Longo, N.; Battaglia, G.; Marcantoni, C.; Giannetto, G.; Tumino, G.; Randazzo, F.; Bellissimo, L.; Faro, F. L.; Grippaldi, F.; Urso, S.; Quattrone, G.; Todaro, I.; Vincenzo, D.; Murgo, A.; Masuzzo, M.; Pisacane, A.; Monardo, P.; Santoro, D.; Pontorierro, M.; Quari, C.; Bauro, A.; Chimenz, R. R.; Alfio, D.; Girasole, F.; Cascio, A. L.; Caviglia, A.; Tornese, F.; Sirna, F.; Altieri, C.; Cusumano, R.; Saveriano, V.; La Corte, A.; Locascio, G.; Rotolo, U.; Rome, M.; Musso, S.; Risuglia, L.; Blanco, G.; Minardo, G.; Castellino, S.; Zappulla, Z.; Randone, S.; Di Francesca, M.; Cassetti, C. C.; Oddo, G.; Buscaino, G.; Mucaria, F.; Barraco, V. I.; Di Martino, A.; Mucaria, F.; Rallo, D.; Dani, L.; Campolo, G.; Manescalchi, F.; Biagini, M.; Agate, M.; Panichi, V.; Casani, A.; Traversari, L.; Garosi, G.; Brunori, G.; Tabbi, M.; Selvi, A.; Cencioni, L.; Fagugli, R.; Timio, F.; Leveque, A.; Manes, M.; Mennella, G.; Calo, L.; Fiorini, F.; Abaterusso, C.; Calzavara, P.; Nordio, M.; Meneghel, G.; Bonesso, C.; Gambaro, G.; Gammaro, L.; Rugiu, C.; Dell'Aquila, R.; Dell'Aquila, R.; Ronco, C.; Rugiu, C

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Background and aim: Over 80% (365/454) of the nation\u2019s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20\u20131.51], positive healthcare workers (IRR 1.09, 95% CI 1.02\u20131.17), test-all policy (IRR 5.94, 95% CI 3.36\u201310.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001\u20131.003) (all p &lt; 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94\u20130.98) (p &lt; 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence 65 229 per 100,000 and at 65 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center\u2019s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Over 80% (365/454) of the nation's centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment

Risk factors and action thresholds for the novel coronavirus pandemic. Insights from the Italian Society of Nephrology COVID-19 Survey

Background and aim: Over 80% (365/454) of the nation’s centers participated in the Italian Society of Nephrology COVID-19 Survey. Out of 60,441 surveyed patients, 1368 were infected as of April 23rd, 2020. However, center-specific proportions showed substantial heterogeneity. We therefore undertook new analyses to identify explanatory factors, contextual effects, and decision rules for infection containment. Methods: We investigated fixed factors and contextual effects by multilevel modeling. Classification and Regression Tree (CART) analysis was used to develop decision rules. Results: Increased positivity among hemodialysis patients was predicted by center location [incidence rate ratio (IRR) 1.34, 95% confidence interval (CI) 1.20–1.51], positive healthcare workers (IRR 1.09, 95% CI 1.02–1.17), test-all policy (IRR 5.94, 95% CI 3.36–10.45), and infected proportion in the general population (IRR 1.002, 95% CI 1.001–1.003) (all p &lt; 0.01). Conversely, lockdown duration exerted a protective effect (IRR 0.95, 95% CI 0.94–0.98) (p &lt; 0.01). The province-contextual effects accounted for 10% of the total variability. Predictive factors for peritoneal dialysis and transplant cases were center location and infected proportion in the general population. Using recursive partitioning, we identified decision thresholds at general population incidence ≥ 229 per 100,000 and at ≥ 3 positive healthcare workers. Conclusions: Beyond fixed risk factors, shared with the general population, the increased and heterogeneous proportion of positive patients is related to the center’s testing policy, the number of positive patients and healthcare workers, and to contextual effects at the province level. Nephrology centers may adopt simple decision rules to strengthen containment measures timely