Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI
<p><strong>Background</strong> Antihypertensives reduce the risk of cardiovascular disease but are also associated with harms including acute kidney injury (AKI). Few data exist to guide clinical decision making regarding these risks.</p> <p><strong>Aim</stron...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Royal College of General Practitioners
2023
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| _version_ | 1826310905196969984 |
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| author | Koshiaris, C Archer, L Lay-Flurrie, S Snell, KIE Riley, RD Stevens, R Banerjee, A Usher-Smith, JA Clegg, A Payne, RA Ogden, M Hobbs, FDR McManus, RJ Sheppard, JP |
| author_facet | Koshiaris, C Archer, L Lay-Flurrie, S Snell, KIE Riley, RD Stevens, R Banerjee, A Usher-Smith, JA Clegg, A Payne, RA Ogden, M Hobbs, FDR McManus, RJ Sheppard, JP |
| author_sort | Koshiaris, C |
| collection | OXFORD |
| description | <p><strong>Background</strong> Antihypertensives reduce the risk of cardiovascular disease but are also associated with harms including acute kidney injury (AKI). Few data exist to guide clinical decision making regarding these risks.</p>
<p><strong>Aim</strong> To develop a prediction model estimating the risk of AKI in people potentially indicated for antihypertensive treatment.</p>
<p><strong>Design and setting</strong> Observational cohort study using routine primary care data from the Clinical Practice Research Datalink (CPRD) in England.</p>
<p><strong>Method</strong> People aged ≥40 years, with at least one blood pressure measurement between 130 mmHg and 179 mmHg were included. Outcomes were admission to hospital or death with AKI within 1, 5, and 10 years. The model was derived with data from CPRD GOLD (<i>n</i> = 1 772 618), using a Fine–Gray competing risks approach, with subsequent recalibration using pseudo-values. External validation used data from CPRD Aurum (<i>n</i> = 3 805 322).</p>
<p><strong>Results</strong> The mean age of participants was 59.4 years and 52% were female. The final model consisted of 27 predictors and showed good discrimination at 1, 5, and 10 years (C-statistic for 10-year risk 0.821, 95% confidence interval [CI] = 0.818 to 0.823). There was some overprediction at the highest predicted probabilities (ratio of observed to expected event probability for 10-year risk 0.633, 95% CI = 0.621 to 0.645), affecting patients with the highest risk. Most patients (>95%) had a low 1- to 5-year risk of AKI, and at 10 years only 0.1% of the population had a high AKI and low CVD risk.</p>
<p><strong>Conclusion</strong> This clinical prediction model enables GPs to accurately identify patients at high risk of AKI, which will aid treatment decisions. As the vast majority of patients were at low risk, such a model may provide useful reassurance that most antihypertensive treatment is safe and appropriate while flagging the few for whom this is not the case.</p> |
| first_indexed | 2024-03-07T07:58:56Z |
| format | Journal article |
| id | oxford-uuid:5e942a14-9329-4bc2-89e5-93c0917615cb |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:58:56Z |
| publishDate | 2023 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:5e942a14-9329-4bc2-89e5-93c0917615cb2023-09-14T13:14:09ZPredicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKIJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5e942a14-9329-4bc2-89e5-93c0917615cbEnglishSymplectic ElementsRoyal College of General Practitioners2023Koshiaris, CArcher, LLay-Flurrie, SSnell, KIERiley, RDStevens, RBanerjee, AUsher-Smith, JAClegg, APayne, RAOgden, MHobbs, FDRMcManus, RJSheppard, JP<p><strong>Background</strong> Antihypertensives reduce the risk of cardiovascular disease but are also associated with harms including acute kidney injury (AKI). Few data exist to guide clinical decision making regarding these risks.</p> <p><strong>Aim</strong> To develop a prediction model estimating the risk of AKI in people potentially indicated for antihypertensive treatment.</p> <p><strong>Design and setting</strong> Observational cohort study using routine primary care data from the Clinical Practice Research Datalink (CPRD) in England.</p> <p><strong>Method</strong> People aged ≥40 years, with at least one blood pressure measurement between 130 mmHg and 179 mmHg were included. Outcomes were admission to hospital or death with AKI within 1, 5, and 10 years. The model was derived with data from CPRD GOLD (<i>n</i> = 1 772 618), using a Fine–Gray competing risks approach, with subsequent recalibration using pseudo-values. External validation used data from CPRD Aurum (<i>n</i> = 3 805 322).</p> <p><strong>Results</strong> The mean age of participants was 59.4 years and 52% were female. The final model consisted of 27 predictors and showed good discrimination at 1, 5, and 10 years (C-statistic for 10-year risk 0.821, 95% confidence interval [CI] = 0.818 to 0.823). There was some overprediction at the highest predicted probabilities (ratio of observed to expected event probability for 10-year risk 0.633, 95% CI = 0.621 to 0.645), affecting patients with the highest risk. Most patients (>95%) had a low 1- to 5-year risk of AKI, and at 10 years only 0.1% of the population had a high AKI and low CVD risk.</p> <p><strong>Conclusion</strong> This clinical prediction model enables GPs to accurately identify patients at high risk of AKI, which will aid treatment decisions. As the vast majority of patients were at low risk, such a model may provide useful reassurance that most antihypertensive treatment is safe and appropriate while flagging the few for whom this is not the case.</p> |
| spellingShingle | Koshiaris, C Archer, L Lay-Flurrie, S Snell, KIE Riley, RD Stevens, R Banerjee, A Usher-Smith, JA Clegg, A Payne, RA Ogden, M Hobbs, FDR McManus, RJ Sheppard, JP Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title | Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title_full | Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title_fullStr | Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title_full_unstemmed | Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title_short | Predicting the risk of acute kidney injury in primary care: derivation and validation of STRATIFY-AKI |
| title_sort | predicting the risk of acute kidney injury in primary care derivation and validation of stratify aki |
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