A systematic review of risk prediction models conducted by Justin Echouffo-Tcheugui and Andre Kengne examines the evidence base for prediction of chronic kidney disease risk and its progression, and suitability of such models for clinical use

Echouffo-Tcheugui, Justin B

Kengne, Andre P

PLoS Medicine

PubMed

<div><h3>Background</h3><p>Chronic kidney disease (CKD) is common, and associated with increased risk of cardiovascular disease and end-stage renal disease, which are potentially preventable through early identification and treatment of individuals at risk. Although risk factors for occurrence and progression of CKD have been identified, their utility for CKD risk stratification through prediction models remains unclear. We critically assessed risk models to predict CKD and its progression, and evaluated their suitability for clinical use.</p> <h3>Methods and Findings</h3><p>We systematically searched MEDLINE and Embase (1 January 1980 to 20 June 2012). Dual review was conducted to identify studies that reported on the development, validation, or impact assessment of a model constructed to predict the occurrence/presence of CKD or progression to advanced stages. Data were extracted on study characteristics, risk predictors, discrimination, calibration, and reclassification performance of models, as well as validation and impact analyses. We included 26 publications reporting on 30 CKD occurrence prediction risk scores and 17 CKD progression prediction risk scores. The vast majority of CKD risk models had acceptable-to-good discriminatory performance (area under the receiver operating characteristic curve>0.70) in the derivation sample. Calibration was less commonly assessed, but overall was found to be acceptable. Only eight CKD occurrence and five CKD progression risk models have been externally validated, displaying modest-to-acceptable discrimination. Whether novel biomarkers of CKD (circulatory or genetic) can improve prediction largely remains unclear, and impact studies of CKD prediction models have not yet been conducted. Limitations of risk models include the lack of ethnic diversity in derivation samples, and the scarcity of validation studies. The review is limited by the lack of an agreed-on system for rating prediction models, and the difficulty of assessing publication bias.</p> <h3>Conclusions</h3><p>The development and clinical application of renal risk scores is in its infancy; however, the discriminatory performance of existing tools is acceptable. The effect of using these models in practice is still to be explored.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div

Justin B. Echouffo-Tcheugui (118178)

Andre P. Kengne (118180)

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Risk Models to Predict Chronic Kidney Disease and Its Progression: A Systematic Review

Cape Town University OpenUCT

Risk models to predict chronic kidney disease and its progression: a systematic review

BackgroundChronic kidney disease (CKD) is common, and associated with increased risk of cardiovascular disease and end-stage renal disease, which are potentially preventable through early identification and treatment of individuals at risk. Although risk factors for occurrence and progression of CKD have been identified, their utility for CKD risk stratification through prediction models remains unclear. We critically assessed risk models to predict CKD and its progression, and evaluated their suitability for clinical use.Methods and findingsWe systematically searched MEDLINE and Embase (1 January 1980 to 20 June 2012). Dual review was conducted to identify studies that reported on the development, validation, or impact assessment of a model constructed to predict the occurrence/presence of CKD or progression to advanced stages. Data were extracted on study characteristics, risk predictors, discrimination, calibration, and reclassification performance of models, as well as validation and impact analyses. We included 26 publications reporting on 30 CKD occurrence prediction risk scores and 17 CKD progression prediction risk scores. The vast majority of CKD risk models had acceptable-to-good discriminatory performance (area under the receiver operating characteristic curve>0.70) in the derivation sample. Calibration was less commonly assessed, but overall was found to be acceptable. Only eight CKD occurrence and five CKD progression risk models have been externally validated, displaying modest-to-acceptable discrimination. Whether novel biomarkers of CKD (circulatory or genetic) can improve prediction largely remains unclear, and impact studies of CKD prediction models have not yet been conducted. Limitations of risk models include the lack of ethnic diversity in derivation samples, and the scarcity of validation studies. The review is limited by the lack of an agreed-on system for rating prediction models, and the difficulty of assessing publication bias.ConclusionsThe development and clinical application of renal risk scores is in its infancy; however, the discriminatory performance of existing tools is acceptable. The effect of using these models in practice is still to be explored

Justin B Echouffo-Tcheugui

Andre P Kengne

Directory of Open Access Journals

Risk models to predict chronic kidney disease and its progression: a systematic review.

Justin B. Echouffo-Tcheugui

Andre P. Kengne

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A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.

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Amedia CA Jr

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History and mission. Available: http:// www.tsn.org.tw/englishVersion/History.aspx.

Improving Global Outcomes

Japanese Society for Dialysis Therapy

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Risk prediction models: I. development, internal validation, and assessing the incremental value of a new (bio)marker.

Risk prediction models: II. external validation, model updating, and impact assessment.

Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy: the RENAAL study.

Risk stratification for progression of IgA nephropathy using a decision tree induction algorithm.

Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience.

SCreening for Occult REnal Disease (SCORED): a simple prediction model for chronic kidney disease.

Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: a systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline.

Translating clinical research into clinical practice: impact of using prediction rules to make decisions.

Validation and comparison of a novel screening guideline for kidney disease: KEEPing SCORED.

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Risk models to predict chronic kidney disease and its progression: a systematic review

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