April 12th, 2011

Two Studies Try to Improve Risk Prediction for Kidney Disease Progression

Two papers presented at the World Congress of Nephrology and simultaneously published online in JAMA raise hope for better tools to calculate the risk for developing kidney failure, but the techniques are not yet ready for clinical use, according to an accompanying editorial.

In the first study, Carmen Peralta and colleagues evaluated a triple-marker strategy combining creatinine, cystatin C, and urine albumin-to-creatinine ratio (ACR) using data from 26,643 U.S. subjects enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. They found that cystatin C and albuminuria “were both strongly and independently associated with all-cause death among persons with or without CKD defined by creatinine-based estimated GFR.”

In the second study, Navdeep Tangri and colleagues used data from two Canadian cohorts of patients with CKD to develop and validate a model to assess the risk for disease progression using routinely measured variables. The model they developed included age, sex, estimated GFR, albuminuria, serum calcium, serum phosphate, serum bicarbonate, and serum albumin and was more accurate than a simpler model in the validation cohort.

In an accompanying editorial, Marcello Tonelli and Braden Manns say that neither study should be considered definitive, but “they provide proof of concept for 2 new methods that could be used to enhance prognostic power.” Both studies, they write, “are novel and important.” But the bigger challenge is to “demonstrate that using better risk prediction tools will lead to clinically meaningful benefit for patients.”

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