Kenichi Nakajima1, Satoko Nakamura2,3, Hiroki Hase4, Yasuchika Takeishi5, Shigeyuki Nishimura6, Yuhei Kawano2,7, Tsunehiko Nishimura8. 1. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, 920-8641, Japan. 2. Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan. 3. Kansai University of Welfare Sciences, Kashihara, Japan. 4. Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan. 5. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan. 6. Saitama Medical University International Medical Center, Hidaka, Japan. 7. Department of Medical Technology, Teikyo University, Fukuoka, Japan. 8. Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawara-machi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. nisimura@koto.kpu-m.ac.jp.
Abstract
BACKGROUND: This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD). METHODS AND RESULTS: Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m2, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m2. CONCLUSION: The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m2, but patients with eGFR < 15 mL/min/1.73 m2 are potentially at high risk regardless of estimated risk values.
BACKGROUND: This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD). METHODS AND RESULTS: Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m2, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m2. CONCLUSION: The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m2, but patients with eGFR < 15 mL/min/1.73 m2 are potentially at high risk regardless of estimated risk values.
Authors: Rory Hachamovitch; Sean W Hayes; John D Friedman; Ishac Cohen; Daniel S Berman Journal: J Am Coll Cardiol Date: 2005-03-01 Impact factor: 24.094
Authors: Leslee J Shaw; Daniel S Berman; Robert C Hendel; Naomi Alazraki; Elizabeth Krawczynska; Salvador Borges-Neto; Jamshid Maddahi; Manuel Cerqueira Journal: Am J Cardiol Date: 2006-04-03 Impact factor: 2.778