Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort
Abstract Background The consequences of chronic kidney disease (CKD) can be addressed with a range of pharmacotherapies primarily prescribed by nephrologists. More accurate information regarding future CKD-related pharmacotherapy requirements could guide clinical decisions including follow-up freque...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-024-03497-y |
| _version_ | 1797275530403250176 |
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| author | Eleni Stamellou Turgay Saritas Marc Froissart Florian Kronenberg Peter Stenvinkel David C. Wheeler Kai-Uwe Eckardt Jürgen Floege James Fotheringham |
| author_facet | Eleni Stamellou Turgay Saritas Marc Froissart Florian Kronenberg Peter Stenvinkel David C. Wheeler Kai-Uwe Eckardt Jürgen Floege James Fotheringham |
| author_sort | Eleni Stamellou |
| collection | DOAJ |
| description | Abstract Background The consequences of chronic kidney disease (CKD) can be addressed with a range of pharmacotherapies primarily prescribed by nephrologists. More accurate information regarding future CKD-related pharmacotherapy requirements could guide clinical decisions including follow-up frequency. Methods Following assignment to derivation and validation groups (2,1), variables predicting individually future use of vitamin D receptor agonists (VDRA), phosphate binders, erythropoiesis stimulating agents (ESAs) and iron were identified using logistic regression in a prospective cohort study containing demography, comorbidity, hospitalization, laboratory, and mortality data in patients with CKD stage G4/G5 across six European countries. Discriminative ability was measured using C-statistics, and predicted probability of medication use used to inform follow-up frequency. Results A total of 2196 patients were included in the analysis. During a median follow-up of 735 days 648 initiated hemodialysis and 1548 did not. Combinations of age, diabetes status and iPTH, calcium, hemoglobin and serum albumin levels predicted the use of ESA, iron, phosphate binder or VDRA, with C-statistics of 0.70, 0.64, 0.73 and 0.63 in derivation cohorts respectively. Model performance in validation cohorts were similar. Sixteen percent of patients were predicted to have a likelihood of receiving any of these medications of less than 20%. Conclusions In a multi-country CKD cohort, prediction of ESA and phosphate binder use over a two-year period can be made based on patient characteristics with the potential to reduce frequency of follow-up in individuals with low risk for requiring these medications. |
| first_indexed | 2024-03-07T15:14:42Z |
| format | Article |
| id | doaj.art-17720dd38736438e84f2e30296ffc31c |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-03-07T15:14:42Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-17720dd38736438e84f2e30296ffc31c2024-03-05T17:57:24ZengBMCBMC Nephrology1471-23692024-02-012511910.1186/s12882-024-03497-yIdentifying individuals at risk of needing CKD associated medications in a European kidney disease cohortEleni Stamellou0Turgay Saritas1Marc Froissart2Florian Kronenberg3Peter Stenvinkel4David C. Wheeler5Kai-Uwe Eckardt6Jürgen Floege7James Fotheringham8Division of Nephrology and Clinical Immunology, RWTH University of AachenDivision of Nephrology and Clinical Immunology, RWTH University of AachenCentre de Recherche Clinique (CRC), Lausanne University HospitalDepartment of Genetics, Institute of Genetic Epidemiology, Medical University of InnsbruckDivision of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska InstitutetDepartment of Renal Medicine, University College LondonDepartment of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin BerlinDivision of Nephrology and Clinical Immunology, RWTH University of AachenNorthern General Hospital, Sheffield Kidney InstituteAbstract Background The consequences of chronic kidney disease (CKD) can be addressed with a range of pharmacotherapies primarily prescribed by nephrologists. More accurate information regarding future CKD-related pharmacotherapy requirements could guide clinical decisions including follow-up frequency. Methods Following assignment to derivation and validation groups (2,1), variables predicting individually future use of vitamin D receptor agonists (VDRA), phosphate binders, erythropoiesis stimulating agents (ESAs) and iron were identified using logistic regression in a prospective cohort study containing demography, comorbidity, hospitalization, laboratory, and mortality data in patients with CKD stage G4/G5 across six European countries. Discriminative ability was measured using C-statistics, and predicted probability of medication use used to inform follow-up frequency. Results A total of 2196 patients were included in the analysis. During a median follow-up of 735 days 648 initiated hemodialysis and 1548 did not. Combinations of age, diabetes status and iPTH, calcium, hemoglobin and serum albumin levels predicted the use of ESA, iron, phosphate binder or VDRA, with C-statistics of 0.70, 0.64, 0.73 and 0.63 in derivation cohorts respectively. Model performance in validation cohorts were similar. Sixteen percent of patients were predicted to have a likelihood of receiving any of these medications of less than 20%. Conclusions In a multi-country CKD cohort, prediction of ESA and phosphate binder use over a two-year period can be made based on patient characteristics with the potential to reduce frequency of follow-up in individuals with low risk for requiring these medications.https://doi.org/10.1186/s12882-024-03497-yCKD G4/G5CKD-MBDRenal anemiaESAsVDRAPhosphate binders |
| spellingShingle | Eleni Stamellou Turgay Saritas Marc Froissart Florian Kronenberg Peter Stenvinkel David C. Wheeler Kai-Uwe Eckardt Jürgen Floege James Fotheringham Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort BMC Nephrology CKD G4/G5 CKD-MBD Renal anemia ESAs VDRA Phosphate binders |
| title | Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort |
| title_full | Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort |
| title_fullStr | Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort |
| title_full_unstemmed | Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort |
| title_short | Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort |
| title_sort | identifying individuals at risk of needing ckd associated medications in a european kidney disease cohort |
| topic | CKD G4/G5 CKD-MBD Renal anemia ESAs VDRA Phosphate binders |
| url | https://doi.org/10.1186/s12882-024-03497-y |
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