title: Evaluating risk of ESRD in the urban poor.
abstract: The capacity of risk prediction to guide management of CKD in underserved health settings is unknown. We conducted a retrospective cohort study of 28,779 adults with nondialysis-requiring CKD who received health care in two large safety net health systems during 1996-2009 and were followed for ESRD through September of 2011. We developed and evaluated the performance of ESRD risk prediction models using recently proposed criteria designed to inform population health approaches to disease management: proportion of cases followed and proportion that needs to be followed. Overall, 1730 persons progressed to ESRD during follow-up (median follow-up=6.6 years). ESRD risk for time frames up to 5 years was highly concentrated among relatively few individuals. A predictive model using five common variables (age, sex, race, eGFR, and dipstick proteinuria) performed similarly to more complex models incorporating extensive sociodemographic and clinical data. Using this model, 80% of individuals who eventually developed ESRD were among the 5% of cohort members at the highest estimated risk for ESRD at 1 year. Similarly, a program that followed 8% and 13% of individuals at the highest ESRD risk would have included 80% of those who eventually progressed to ESRD at 3 and 5 years, respectively. In this underserved health setting, a simple five-variable model accurately predicts most cases of ESRD that develop within 5 years. Applying risk prediction using a population health approach may improve CKD surveillance and management of vulnerable groups by directing resources to a small subpopulation at highest risk for progressing to ESRD.
authors.affiliation: Kidney Research Institute, Department of Medicine, Department of Biostatistics, and.
authors.forename: Marlena
authors.initials: M
authors.lastname: Maziarz
authors.affiliation: Biomedical Informatics Consult Team, Institute of Translational Health Sciences, University of Washington, Seattle, Washington; and.
authors.forename: R Anthony
authors.initials: RA
authors.lastname: Black
authors.affiliation: Biomedical Informatics Consult Team, Institute of Translational Health Sciences, University of Washington, Seattle, Washington; and.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Fong
authors.affiliation: Kidney Research Institute, Department of Medicine.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: School of Medicine, Stanford University, Palo Alto, California.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Kidney Research Institute, Department of Medicine, ynhall@uw.edu.
authors.forename: Yoshio N
authors.initials: YN
authors.lastname: Hall
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D014505:Urban Population; D014861:Washington / Q000453:epidemiology
keywords: CKD; ESRD; ethnic; minority; progression of chronic renal failure