Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort

BMC Nephrology, vol. 25, pp. 60

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.

Authors 9

1. Eleni Stamellou corresponding Aachen Division of Nephrology and Clinical Immunology

   RWTH Aachen University · University Hospital of Ioannina

   Affiliation as printed

   Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece. stamellou.eleni@gmail.com

   Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany. stamellou.eleni@gmail.com

2. Turgay Saritas Aachen Division of Nephrology and Clinical Immunology

   RWTH Aachen University

   Affiliation as printed

   Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany

3. Marc Froissart

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Centre de Recherche Clinique (CRC), Lausanne University Hospital, Lausanne, Switzerland

4. Florian Kronenberg

   Innsbruck Medical University · Universität Innsbruck

   Affiliation as printed

   Department of Genetics, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria

5. Peter Stenvinkel

   Karolinska Institutet

   Affiliation as printed

   Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

6. David Collins. Wheeler

   University College London

   Affiliation as printed

   Department of Renal Medicine, University College London, London, United Kingdom

7. Kai‐Uwe Eckardt

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany

8. Jürgen Floege Aachen Division of Nephrology and Clinical Immunology

   RWTH Aachen University

   Affiliation as printed

   Division of Nephrology and Clinical Immunology, RWTH University of Aachen, Aachen, Germany

9. James Fotheringham

   University of Sheffield · Sheffield Kidney Institute · Northern General Hospital

   Affiliation as printed

   Northern General Hospital, Sheffield Kidney Institute, Herries Road, Sheffield, South Yorkshire, S5 7AU, United Kingdom

   School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom