Nomogram tool can predict risk of CRF in patients at high risk of developing cardiovascular disease


A nomogram tool using 5 predictors has been shown to be a simple and reliable way to stratify chronic kidney disease (CKD) risk among high-risk populations, according to a recent analysis of patients at high risk for cardiovascular disease.

In the Chinese retrospective study, published in BMJ Open, investigators said the tool could allow doctors to identify individuals at high risk for developing CKD so they can implement specific prevention strategies sooner.

“Using demographic, clinical and laboratory variables from electronic health records, our nomogram visualized with only five variables… demonstrated good discriminating power, which allows us to easily identify patients at high risk of incidence of IRC, ”investigators wrote.

CRF is difficult to treat because it is often asymptomatic and diagnosed late. Along with hypertension and diabetes, CRF has been identified as an independent risk factor for cardiovascular disease (CVD) and all-cause mortality. Populations at high risk for cardiovascular disease often take drugs for multiple co-morbidities, such as blood pressure drugs, diabetes drugs, antithrombotic agents, which can increase the load on the kidneys.

Risk prediction tools to identify individual CKD incident risks could improve primary care for CRF. However, the primary health care system in China often faces a shortage of medical personnel, insufficient government funding, and high labor intensity, which suggests that the use of conventional data in the medical system, in More to improve chronic disease management methods, is needed to build a CKD risk prediction model.

“The ability to identify those at risk for incidence of CKD can reduce the incidence of CVD … For these people, the early identification of those at high risk of CKD is of great importance to guide prevention.” and treatment, ”the investigators noted.

Study participants were recruited through the National Basic Public Health Service Project in Guangzhou, China, between January 2015 and December 2020. To participate, patients had to be 65 years of age or older or older. ” at least 35 years old if they have diabetes or high blood pressure. The current analysis included patients with a 5-year cardiovascular risk score of 20% or greater.

A total of 5730 patients at high risk of CVD were classified into the development cohort (n = 3820) and the validation cohort (n = 1910). The mean age (SD) of the entire cohort was 68.64 (6.49) years and the median eGFR was 92.95 ml / min / 1.732.

Among the patients in the development cohort, those who developed CKD were often older, had a higher body mass index (BMI), and had a larger waist circumference than those who did not have a CKD. During laboratory tests, patients who developed CRF had lower glomerular filtration rate (eGFR) and platelet count as well as higher uric acid and triglyceride content than patients without CRF. Patients who developed CKD during the follow-up period were also more likely to have high blood pressure and diabetes, and less likely to be smokers or drinkers.

During the median follow-up period of 4.22 years, incident CRD was present in 19.09% (n = 1094) of the total, including 19.03% (n = 727) of the development cohort and 19.21% (n = 367) of the validation cohort. Death occurred in 23 (0.4%) patients during the follow-up period, of whom 7 died after developing CKD and 16 died without developing CKD.

Using multivariate COX regression analysis and step-back approach, age (HR, 1.07; 95% CI, 1.06-1.08), BMI (HR, 1, 04; 95% CI, 1.02-1.06), an eGFR between 60 and 89 ml / min / 1.732 (HR, 5.59; 95% CI, 4.70-6.65), diabetes (HR, 1.63; 95% CI, 1.38 to 1.91) and hypertension (HR, 1.40; 95% CI, 1.13 to 1.75) were selected as predictors of the IRC incident.

In both groups, the nomogram developed by the researchers demonstrated good discriminating power with a C index of 0.778 in the development cohort and 0.785 in the validation cohort. The areas under the curve (AUC) in the 3-year, 4-year, and 5-year development cohort were 0.817, 0.814, and 0.834, respectively. AUCs in the validation cohort were 0.830, 0.847, and 0.839 at 3 years, 4 years, and 5 years, respectively. The nomogram also showed that it was able to distinguish patients at high risk for CRF from those at low risk at 3 years, 4 years and 5 years.

Investigators noted the lack of albuminuria data for the majority of patients and concerns about the definition used for their endpoint eGFR as study limitations. In addition, there was no external validation of the investigator’s model.

“More studies focusing on the clinical significance of different declines in eGFR are needed,” they wrote.


Zhang Q, Zhang J, Lei L et al. Nomogram for predicting the risk of incident chronic kidney disease in the population at high risk for cardiovascular disease in China: Community cohort study. BMJ Open. Published online November 12, 2021. Accessed December 1, 2021. doi: 10.1136 / bmjopen-2020-047774

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