Evidence map›Paper›PMID 30302267›Full record

ArticleCanadian journal of kidney health and disease2018

Predicting 3-Year Survival in Patients Receiving Maintenance Dialysis: An External Validation of iChoose Kidney in Ontario, Canada.

Vivian S Tan, Amit X Garg, Eric McArthur, Rachel E Patzer, Jennifer Gander, Pavel Roshanov, S Joseph Kim, Greg A Knoll, Seychelle Yohanna, Megan K McCallum and 1 more

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Article in Canadian journal of kidney health and disease, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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4citing papers in PubMed
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4 citing papers in PubMed.

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5 · Who and what money

Authors and funding

11 authors.

Vivian S TanDivision of Nephrology, Western University, London, ON, Canada.
Amit X GargDivision of Nephrology, Western University, London, ON, Canada.
Eric McArthurInstitute for Clinical Evaluative Sciences, London, ON, Canada.
Rachel E PatzerDepartment of Surgery, Emory University, Atlanta, GA, USA.
Jennifer GanderKaiser Permanente, Atlanta, GA, USA.
Pavel RoshanovDepartment of Medicine, McMaster University, Hamilton, ON, Canada.ORCID https://orcid.org/0000-0003-3908-1955
S Joseph KimUniversity Health Network, University of Toronto, ON, Canada.
Greg A KnollDivision of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada.
Seychelle YohannaDivision of Nephrology, McMaster University, Hamilton, ON, Canada.
Megan K McCallumInstitute for Clinical Evaluative Sciences, London, ON, Canada.
Kyla L NaylorInstitute for Clinical Evaluative Sciences, London, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMany patients with end-stage kidney disease (ESKD) do not appreciate how their survival may differ if treated with a kidney transplant compared with dialysis. A risk calculator (iChoose Kidney) developed and validated in the United States provides individualized mortality estimates for different treatment options (dialysis vs living or deceased donor kidney transplantation). The calculator can be used with patients and families to help patients make more educated treatment decisions.

objectiveTo validate the iChoose Kidney risk calculator in Ontario, Canada.

designExternal validation study.

settingWe used several linked administrative health care databases from Ontario, Canada. PATIENTS: We included 22 520 maintenance dialysis patients and 4505 kidney transplant recipients. Patients entered the cohort between 2004 and 2014. MEASUREMENTS: Three-year all-cause mortality.

methodsWe assessed model discrimination using the C-statistic. We assessed model calibration by comparing the observed versus predicted mortality risk and by using smoothed calibration plots. We used multivariable logistic regression modeling to recalibrate model intercepts using a correction factor, when appropriate.

resultsIn our final version of the iChoose Kidney model, we included the following variables: age (18-80 years), sex (male, female), race (white, black, other), time on dialysis (<6 months, 6-12 months, >12 months), and patient comorbidities (hypertension, diabetes, and/or cardiovascular disease). Over the 3-year follow-up period, 33.3% of dialysis patients and 6.2% of kidney transplant recipients died. The discriminatory ability was moderate (C-statistic for dialysis: 0.70, 95% confidence interval [CI]: 0.69-0.70, and C-statistic for transplant: 0.72, 95% CI: 0.69-0.75). The 3-year observed and predicted mortality estimates were comparable and even more so after we recalibrated the intercepts in 2 of our models (dialysis and deceased donor kidney transplantation). As done in the United States, we developed a Canadian Web site and an iOS application called Dialysis vs. Kidney Transplant- Estimated Survival in Ontario. LIMITATIONS: Missing data in our databases precluded the inclusion of all variables that were in the original iChoose Kidney (ie, patient ethnicity and low albumin). We were unable to perform all preplanned analyses due to the limited sample size.

conclusionsThe original iChoose Kidney risk calculator was able to adequately predict mortality in this Canadian (Ontario) cohort of ESKD patients. After minor modifications, the predictive accuracy improved. The Dialysis vs. Kidney Transplant- Estimated Survival in Ontario risk calculator may be a valuable resource to help ESKD patients make an informed decision on pursuing kidney transplantation.

Indexed as

external validationiChoose Kidneykidney transplantationmaintenance dialysismortalityrisk calculatorsurvival

Identifiers

PMID30302267
PMCPMC6172940

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