BACKGROUND Patients with chronic kidney disease (CKD) are at high risk of end-stage kidney disease (ESKD). The Kidney Failure Risk Equation (KFRE), which predicts ESKD risk among patients with CKD, has not been validated in primary care clinics in Southeast Asia (SEA). Therefore, we aimed to (1) evaluate the performance of existing KFRE equations, (2) recalibrate KFRE for better predictive precision, and (3) identify optimally feasible KFRE thresholds for nephrologist referral and dialysis planning in SEA. METHODS All patients with CKD visiting nine primary care clinics from 2010 to 2013 in Singapore were included and applied 4-variable KFRE equations incorporating age, sex, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR). ESKD onset within two and five years were acquired via linkage to the Singapore Renal Registry. A weighted Brier score (the squared difference between observed vs predicted ESKD risks), bias (the median difference between observed vs predicted ESKD risks) and precision (the interquartile range of the bias) were used to select the best-calibrated KFRE equation. RESULTS The recalibrated KFRE (named Recalibrated Pooled KFRE SEA) performed better than existing and other recalibrated KFRE equations in terms of having a smaller Brier score (square root: 2.8% vs. 4.0-9.3% at 5 years; 2.0% vs. 6.1-9.1% at 2 years), less bias (2.5% vs. 3.3-5.2% at 5 years; 1.8% vs. 3.2-3.6% at 2 years), and improved precision (0.5% vs. 1.7-5.2% at 5 years; 0.5% vs. 3.8-4.2% at 2 years). Area under ROC curve for the Recalibrated Pooled KFRE SEA equations were 0.94 (95% confidence interval [CI]: 0.93 to 0.95) at 5 years and 0.96 (95% CI: 0.95 to 0.97) at 2 years. The optimally feasible KFRE thresholds were > 10-16% for 5-year nephrologist referral and > 45% for 2-year dialysis planning. Using the Recalibrated Pooled KFRE SEA, an estimated 82 and 89% ESKD events were included among 10% of subjects at highest estimated risk of ESKD at 5-year and 2-year, respectively. CONCLUSIONS The Recalibrated Pooled KFRE SEA performs better than existing KFREs and warrants implementation in primary care settings in SEA.

中文翻译：

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东南亚终末期肾脏疾病的肾衰竭风险方程的验证。

背景技术患有慢性肾脏疾病（CKD）的患者处于终末期肾脏疾病（ESKD）的高风险中。预测肾病患者中ESKD风险的肾脏衰竭风险方程（KFRE）在东南亚（SEA）的初级保健诊所中尚未得到验证。因此，我们旨在（1）评估现有KFRE方程的性能，（2）重新校准KFRE以提高预测精度，以及（3）确定SEA中肾脏科医生转诊和透析计划的最佳可行KFRE阈值。方法纳入2010年至2013年在新加坡九家初级保健诊所就诊的所有CKD患者，并应用4变量KFRE方程式，该方程式包括年龄，性别，估计的肾小球滤过率（eGFR）和白蛋白与肌酐比（ACR）。通过与新加坡肾脏病登记处的联系获得了在两年和五年内发病的ESKD。加权Brier得分（观察到的ESKD风险与预期ESKD风险之间的平方差），偏差（观察到的ESKD风险与预测ESKD风险之间的中位数差异）和精度（偏差的四分位数范围）用于选择最佳校准的KFRE方程。结果经过重新校准的KFRE（称为重新校准的合并KFRE SEA）在较小的Brier分数方面（5年后的平方根：2.8％对4.0-9.3％； 2.0％对6.1-）表现优于现有的和其他重新校准的KFRE方程。 2年9.1％），偏见减少（5年2.5％vs.3.3-5.2％; 2年1.8％vs.3.2-3.6％），精度提高（5年0.5％vs.1.7-5.2％ ； 0.5％比2年的3.8-4.2％）。重新校准的合并KFRE SEA方程的ROC曲线下面积为0。在5年时为94（95％置信区间[CI]：0.93至0.95），在2年时为0.96（95％CI：0.95至0.97）。对于5年的肾病医师转诊，最佳可行KFRE阈值> 10-16％，对于2年透析计划，其> 45％。使用重新校准的合并KFRE SEA，在5年期和2年期ESKD估计风险最高的10％的受试者中，估计有82％和89％的ESKD事件被包括在内。结论经过重新校准的合并KFRE SEA的性能要优于现有的KFRE，并保证可以在SEA的初级保健环境中实施。在5年和2年时，估计有最高ESKD风险的受试者中，分别有10％的受试者包括了82％和89％的ESKD事件。结论经过重新校准的合并KFRE SEA的性能要优于现有的KFRE，并保证可以在SEA的初级保健环境中实施。在5年和2年时，估计有最高ESKD风险的受试者中，分别有10％的受试者包括了82％和89％的ESKD事件。结论经过重新校准的合并KFRE SEA的性能要优于现有的KFRE，并保证可以在SEA的初级保健环境中实施。