BACKGROUND: Registry-based studies have identified risk factors for chronic kidney disease (CKD) and for progression to end-stage renal disease. However, usually, these studies do not incorporate sequential measurements of kidney function and provide little information on the prognosis of individual patients. The aim of this study is to identify which combinations of demographic and clinical characteristics are useful to discriminate patients with a differential annual decline in glomerular filtration rate (GFR). METHODS: This observational retrospective study includes patients enlisted in the registry of the Prevention of Progressive Renal Insufficiency Project of Emilia-Romagna region (Italy) from July 2004 to June 2010, with at least four serum creatinine measurements. Classification tree analysis (CTA) was used to identify subgroups of patients with a different annual GFR decline using demographic and laboratory data collected at study entry. RESULTS: The CTA procedure generated seven mutually exclusive groups. Among patients with proteinuria, those with a baseline estimated GFR (eGFR) of >33 mL/min/1.73 m(2) exhibited the fastest illness progression in the study population (-3.655 mL/min/1.73 m(2)), followed by patients with a baseline eGFR of <33 mL/min/1.73 m(2) and a baseline serum phosphorus of >4.3 mg/dL (-2.833 mL/min/1.73 m(2)). Among patients without proteinuria, those aged <67 years exhibited a significantly faster progression, which was even faster for the subgroup with diabetes. Among patients aged >67 years, females had on average a stable eGFR over time, with a large variability. CONCLUSIONS: It is possible to rely on a few variables typically accessible in routine clinical practice to stratify patients with a different CKD progression rate. Stratification can be used to guide decisions about the follow-up schedule, treatments to slow progression of kidney disease, prevent its complications and to begin planning for dialysis and transplantation

A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis / Rucci, P; Mandreoli, M; Gibertoni, D; Zuccalà, A; Fantini, Mp; Lenzi, J; Santoro, A; Collaborators: Scarpioni R, for the Prevention of Renal Insufficiency Progression P. r. o. j. e. c. t.; De Amicis, S; Buzio, C; David, S; Pasquali, S; Corradini, M; Cappelli, Gianni; Olmeda, F; Baraldi, A; Caruso, F; Stefoni, S; Orsi, C; Santoro, A; Cannarile, C; Mandreoli, M; Di Nicolò, P; Storari, A; Russo, G; Buscaroli, A; Monti, M; Mosconi, G; Cristino, S; Feletti, C; Baldrati, L; Rigotti, A; Flachi,. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - STAMPA. - 29:3(2014), pp. 603-610. [10.1093/ndt/gft444]

A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis

CAPPELLI, Gianni;
2014

Abstract

BACKGROUND: Registry-based studies have identified risk factors for chronic kidney disease (CKD) and for progression to end-stage renal disease. However, usually, these studies do not incorporate sequential measurements of kidney function and provide little information on the prognosis of individual patients. The aim of this study is to identify which combinations of demographic and clinical characteristics are useful to discriminate patients with a differential annual decline in glomerular filtration rate (GFR). METHODS: This observational retrospective study includes patients enlisted in the registry of the Prevention of Progressive Renal Insufficiency Project of Emilia-Romagna region (Italy) from July 2004 to June 2010, with at least four serum creatinine measurements. Classification tree analysis (CTA) was used to identify subgroups of patients with a different annual GFR decline using demographic and laboratory data collected at study entry. RESULTS: The CTA procedure generated seven mutually exclusive groups. Among patients with proteinuria, those with a baseline estimated GFR (eGFR) of >33 mL/min/1.73 m(2) exhibited the fastest illness progression in the study population (-3.655 mL/min/1.73 m(2)), followed by patients with a baseline eGFR of <33 mL/min/1.73 m(2) and a baseline serum phosphorus of >4.3 mg/dL (-2.833 mL/min/1.73 m(2)). Among patients without proteinuria, those aged <67 years exhibited a significantly faster progression, which was even faster for the subgroup with diabetes. Among patients aged >67 years, females had on average a stable eGFR over time, with a large variability. CONCLUSIONS: It is possible to rely on a few variables typically accessible in routine clinical practice to stratify patients with a different CKD progression rate. Stratification can be used to guide decisions about the follow-up schedule, treatments to slow progression of kidney disease, prevent its complications and to begin planning for dialysis and transplantation
2014
29
3
603
610
A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis / Rucci, P; Mandreoli, M; Gibertoni, D; Zuccalà, A; Fantini, Mp; Lenzi, J; Santoro, A; Collaborators: Scarpioni R, for the Prevention of Renal Insufficiency Progression P. r. o. j. e. c. t.; De Amicis, S; Buzio, C; David, S; Pasquali, S; Corradini, M; Cappelli, Gianni; Olmeda, F; Baraldi, A; Caruso, F; Stefoni, S; Orsi, C; Santoro, A; Cannarile, C; Mandreoli, M; Di Nicolò, P; Storari, A; Russo, G; Buscaroli, A; Monti, M; Mosconi, G; Cristino, S; Feletti, C; Baldrati, L; Rigotti, A; Flachi,. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - STAMPA. - 29:3(2014), pp. 603-610. [10.1093/ndt/gft444]
Rucci, P; Mandreoli, M; Gibertoni, D; Zuccalà, A; Fantini, Mp; Lenzi, J; Santoro, A; Collaborators: Scarpioni R, for the Prevention of Renal Insuffici...espandi
File in questo prodotto:
File Dimensione Formato  
ndt_2Fgft444.pdf

Accesso riservato

Tipologia: Versione pubblicata dall'editore
Dimensione 250.79 kB
Formato Adobe PDF
250.79 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1023329
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 17
social impact