TY - JOUR
T1 - The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials
AU - Bate, Sebastian
AU - McGovern, Dominic
AU - Costigliolo, Francesca
AU - Tan, Pek Ghe
AU - Kratky, Vojtech
AU - Scott, Jennifer
AU - Chapman, Gavin B.
AU - Brown, Nina
AU - Floyd, Lauren
AU - Brilland, Benoit
AU - Martín-Nares, Eduardo
AU - Aydın, Mehmet Fethullah
AU - Ilyas, Duha
AU - Butt, Arslan
AU - Riogh, Eithne Nic an
AU - Kollar, Marek
AU - Lees, Jennifer S.
AU - Yildiz, Abdülmecit
AU - Hinojosa-Azaola, Andrea
AU - Dhaygude, Ajay
AU - Roberts, Stephen A.
AU - Rosenberg, Avi
AU - Wiech, Thorsten
AU - Pusey, Charles D.
AU - Jones, Rachel B.
AU - Jayne, David R.W.
AU - Bajema, Ingeborg
AU - Jennette, J. Charles
AU - Stevens, Kate I.
AU - Augusto, Jean Francois
AU - Mejía-Vilet, Juan Manuel
AU - Dhaun, Neeraj
AU - McAdoo, Stephen P.
AU - Tesar, Vladimir
AU - Little, Mark A.
AU - Geetha, Duruvu
AU - Brix, Silke R.
N1 - Publisher Copyright:
Copyright © 2023 by the American Society of Nephrology.
PY - 2024/3
Y1 - 2024/3
N2 - 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 (n5959), 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 mmol/L50, K1: 250–450 mmol/L54, K2: .450 mmol/L511 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: .25%50, N1: 10%–25%54, N2:,10%57, T0: none/mild or,25%50, T1: $ mild-moderate or $25%53 points), and four risk groups created: low (0–4 points), moderate (5–11), high (12–18), and very high (21). Discrimination was C50.831, 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 (n5480, C50.821). Conclusions The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
AB - 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 (n5959), 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 mmol/L50, K1: 250–450 mmol/L54, K2: .450 mmol/L511 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: .25%50, N1: 10%–25%54, N2:,10%57, T0: none/mild or,25%50, T1: $ mild-moderate or $25%53 points), and four risk groups created: low (0–4 points), moderate (5–11), high (12–18), and very high (21). Discrimination was C50.831, 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 (n5480, C50.821). Conclusions The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
UR - http://www.scopus.com/inward/record.url?scp=85186319182&partnerID=8YFLogxK
U2 - 10.1681/ASN.0000000000000274
DO - 10.1681/ASN.0000000000000274
M3 - Article
C2 - 38082490
AN - SCOPUS:85186319182
SN - 1046-6673
VL - 35
SP - 335
EP - 346
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 3
ER -