Evaluating a New International Risk-Prediction Tool in IgA Nephropathy

作者：Sean J. Barbour, Rosanna Coppo, Hong Zhang, Zhi-Hong Liu, Yusuke Suzuki, Keiichi Matsuzaki, Ritsuko Katafuchi, Lee Er, Gabriela Espino-Hernández, S. Joseph Kim, Heather N. Reich, John Feehally, Daniel Cattran, International IgA Nephropathy Network · 发表于：JAMA Internal Medicine · 年份：2019 · DOI：10.1001/jamainternmed.2019.0600 · 被引用次数：494 · 研究领域：Renal Diseases and Glomerulopathies、Chronic Kidney Disease and Diabetes、Renal Transplantation Outcomes and Treatments

Importance: Although IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, there is no validated tool to predict disease progression. This limits patient-specific risk stratification and treatment decisions, clinical trial recruitment, and biomarker validation. Objective: To derive and externally validate a prediction model for disease progression in IgAN that can be applied at the time of kidney biopsy in multiple ethnic groups worldwide. Design, Setting, and Participants: We derived and externally validated a prediction model using clinical and histologic risk factors that are readily available in clinical practice. Large, multi-ethnic cohorts of adults with biopsy-proven IgAN were included from Europe, North America, China, and Japan. Main Outcomes and Measures: Cox proportional hazards models were used to analyze the risk of a 50% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease, and were evaluated using the R2D measure, Akaike information criterion (AIC), C statistic, continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI), and calibration plots. Results: The study included 3927 patients; mean age, 35.4 (interquartile range, 28.0-45.4) years; and 2173 (55.3%) were men. The following prediction models were created in a derivation cohort of 2781 patients: a clinical model that included eGFR, blood pressure, and proteinuria at biopsy; and 2 full models that also contained the MEST ...