Researchers Develop Tool to Identify Those at Risk of Future CKD

A simple risk-assessment tool that helps physicians with early identification of patients at increased risk of chronic kidney disease (CKD) could lead to improved and targeted surveillance strategies, according to research published Friday.

The study, published in JAMA, was timed to coincide with a presentation by the investigators at the American Society of Nephrology’s Kidney Week 2019.

According to the study, the tool identified people at increased 5-year risk of CKD, defined as reduced estimated glomerular filtration rate (eGFR), a measure of kidney function. The risk calculator tool was developed by the Chronic Kidney Disease Prognosis Consortium, a large global collaboration led by researchers at the Johns Hopkins Bloomberg School of Public Health.

An estimated 37 million US residents have CKD, and its incidence is rising around the world. Risk factors for CKD include hypertension and diabetes. In addition, patients with CKD face a higher risk of cardiovascular events.

Researchers used data from about 5 million people (more than 4 million adults without diabetes and nearly 800,000 with diabetes) in 28 countries to create risk prediction models. Models were developed separately for people with versus without diabetes and used a mix of variables including age, hypertension, and diabetes status.

CKD with reduced kidney function was defined using eGFR less than 60 ml/min/1.73 m² of body surface area, or half or less of what is seen in a healthy individual. Equations for the 5-year risk of reduced eGFR included age, sex, race/ethnicity, eGFR, history of cardiovascular disease, ever smoker, hypertension, body mass index, and albuminuria concentration.

Among the 4.4 million people without diabetes (mean age = 54 years; 38% women), 660,856 incident cases, or nearly 15%, of reduced eGFR occurred during a mean follow-up of 4.2 years. Of 781,627 participants with diabetes (mean age = 62 years; 13% women), 313,646 incident cases (40%) occurred during a mean follow-up of 3.9 years.

“With the risk equations that we’ve developed, physicians should be able to determine with high accuracy who will or won’t develop chronic kidney disease in the next few years—and our analyses suggest that they can maintain that accuracy in a variety of clinical settings globally,” said Josef Coresh, MD, Chronic Kidney Disease Prognosis Consortium co—principal investigator and the George W. Comstock Professor in the Bloomberg School’s Department of Epidemiology, in a statement.

CKD is a largely silent disease, detectable through kidney function tests, but the ability to pinpoint risk may prevent adverse health outcomes.

Additional areas of research could include looking at whether focusing resources on patients at highest risk of developing CKD improves blood pressure control and/or weight, as well as whether drug therapy to improve albuminuria or control diabetes might prevent occurrence of reduced eGFR.