The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials.

Autor:	Bate S; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom., McGovern D; Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom.; Department of Medicine, University of Cambridge, Cambridge, United Kingdom.; Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom., Costigliolo F; Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy.; Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, Genova, Italy., Tan PG; Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.; Renal Unit, Northern Health, Victoria, Australia., Kratky V; 1st Faculty of Medicine, Charles University, Prague, Czechia.; Department of Nephrology, General University Hospital, Prague, Czechia., Scott J; Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland., Chapman GB; University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom., Brown N; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.; Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom., Floyd L; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.; Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom., Brilland B; Service de Néphrologie-Dialyse-Transplantation, CHU d'Angers, Angers, France., Martín-Nares E; Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Aydın MF; Division of Nephrology, Bursa Uludağ University School of Medicine, Bursa, Turkey., Ilyas D; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.; Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom., Butt A; Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom., Nic An Riogh E; Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland., Kollar M; Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czechia., Lees JS; Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom., Yildiz A; Division of Nephrology, Bursa Uludağ University School of Medicine, Bursa, Turkey., Hinojosa-Azaola A; Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Dhaygude A; Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom., Roberts SA; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom., Rosenberg A; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Wiech T; University Medical Center Hamburg-Eppendorf, Institute of Pathology, Hamburg, Germany., Pusey CD; Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.; Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom., Jones RB; Department of Medicine, University of Cambridge, Cambridge, United Kingdom.; Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom., Jayne DRW; Department of Medicine, University of Cambridge, Cambridge, United Kingdom.; Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom., Bajema I; Department of Pathology, Groningen University Medical Center, Groningen, The Netherlands., Jennette JC; Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Stevens KI; Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom., Augusto JF; Service de Néphrologie-Dialyse-Transplantation, CHU d'Angers, Angers, France., Mejía-Vilet JM; Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Dhaun N; University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom., McAdoo SP; Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.; Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom., Tesar V; 1st Faculty of Medicine, Charles University, Prague, Czechia.; Department of Nephrology, General University Hospital, Prague, Czechia., Little MA; Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland., Geetha D; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Brix SR; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom.; Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2024 Mar 01; Vol. 35 (3), pp. 335-346. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1681/ASN.0000000000000274
Abstrakt:	Significance Statement: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination ( n =480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. Background: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. Methods: The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. Results: Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort ( n =959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: <250 µ mol/L=0, K1: 250-450 µ mol/L=4, K2: >450 µ mol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%-25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0-4 points), moderate (5-11), high (12-18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination ( n =480, C=0.821). Conclusions: The updated score optimizes clinicopathologic prognostication for clinical practice and trials. (Copyright © 2023 by the American Society of Nephrology.)
Databáze:	MEDLINE
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