Development and validation of a prediction rule using the Oxford classification in IgA nephropathy

Shigeru Tanaka, Toshiharu Ninomiya, Ritsuko Katafuchi, Kosuke Masutani, Akihiro Tsuchimoto, Hideko Noguchi, Hideki Hirakata, Kazuhiko Tsuruya, Takanari Kitazono

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Abstract

Background and objectives The risk assessment for developing ESRD remains limited in patients with IgA nephropathy (IgAN). The aim of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with IgAN. Design, setting, participants, & measurements A total of 698 patients with IgAN diagnosed by renal biopsy at Kyushu University Hospital (derivation cohort) between 1982 and 2010 were retrospectively followed. The Oxford classification was used to evaluate the pathologic lesions. The risk factors for developing ESRD were evaluated using a Cox proportional hazard modelwith a stepwise backward eliminationmethod. The prediction rule was verified using data from 702 patients diagnosed at Japanese Red Cross Fukuoka Hospital (validation cohort) between 1979 and 2002. Results In the derivation cohort, 73 patients developed ESRD during the median 4.7-year follow-up. The final prediction model included proteinuria (hazard ratio [HR], 1.30; 95% confidence interval [95% CI], 1.16 to 1.45, every 1 g/24 hours), estimated GFR (HR, 0.84; 95% CI, 0.74 to 0.96, every 10 ml/min per 1.73 m2), mesangial proliferation (HR, 1.85; 95% CI, 1.10 to 3.11), segmental sclerosis (HR, 3.21; 95% CI, 1.37 to 7.51), and interstitial fibrosis/tubular atrophy (T1:HR, 5.30; 95%CI, 2.63 to 10.7; T2:HR, 20.5; 95%CI, 9.05 to 46.5) as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The incidence of ESRD increased linearly with increases in the total risk scores (P for trend <0.001). Furthermore, the prediction rule demonstrated good discrimination (c-statistic=0.89) and calibration (Hosmer-Lemeshow test, P=0.78) in the validation cohort. Conclusions This study developed and validated a new prediction rule using clinical measures and the Oxford classification for developing ESRD in patients with IgAN.

Original languageEnglish
Pages (from-to)2082-2090
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number12
DOIs
Publication statusPublished - Dec 6 2013

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Immunoglobulin A
Chronic Kidney Failure
Confidence Intervals
Red Cross
Decision Support Techniques
Sclerosis
Proteinuria
Proportional Hazards Models
Calibration
Atrophy
Fibrosis
Kidney
Biopsy
Incidence

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Development and validation of a prediction rule using the Oxford classification in IgA nephropathy. / Tanaka, Shigeru; Ninomiya, Toshiharu; Katafuchi, Ritsuko; Masutani, Kosuke; Tsuchimoto, Akihiro; Noguchi, Hideko; Hirakata, Hideki; Tsuruya, Kazuhiko; Kitazono, Takanari.

In: Clinical Journal of the American Society of Nephrology, Vol. 8, No. 12, 06.12.2013, p. 2082-2090.

Research output: Contribution to journalArticle

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abstract = "Background and objectives The risk assessment for developing ESRD remains limited in patients with IgA nephropathy (IgAN). The aim of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with IgAN. Design, setting, participants, & measurements A total of 698 patients with IgAN diagnosed by renal biopsy at Kyushu University Hospital (derivation cohort) between 1982 and 2010 were retrospectively followed. The Oxford classification was used to evaluate the pathologic lesions. The risk factors for developing ESRD were evaluated using a Cox proportional hazard modelwith a stepwise backward eliminationmethod. The prediction rule was verified using data from 702 patients diagnosed at Japanese Red Cross Fukuoka Hospital (validation cohort) between 1979 and 2002. Results In the derivation cohort, 73 patients developed ESRD during the median 4.7-year follow-up. The final prediction model included proteinuria (hazard ratio [HR], 1.30; 95{\%} confidence interval [95{\%} CI], 1.16 to 1.45, every 1 g/24 hours), estimated GFR (HR, 0.84; 95{\%} CI, 0.74 to 0.96, every 10 ml/min per 1.73 m2), mesangial proliferation (HR, 1.85; 95{\%} CI, 1.10 to 3.11), segmental sclerosis (HR, 3.21; 95{\%} CI, 1.37 to 7.51), and interstitial fibrosis/tubular atrophy (T1:HR, 5.30; 95{\%}CI, 2.63 to 10.7; T2:HR, 20.5; 95{\%}CI, 9.05 to 46.5) as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The incidence of ESRD increased linearly with increases in the total risk scores (P for trend <0.001). Furthermore, the prediction rule demonstrated good discrimination (c-statistic=0.89) and calibration (Hosmer-Lemeshow test, P=0.78) in the validation cohort. Conclusions This study developed and validated a new prediction rule using clinical measures and the Oxford classification for developing ESRD in patients with IgAN.",
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AU - Katafuchi, Ritsuko

AU - Masutani, Kosuke

AU - Tsuchimoto, Akihiro

AU - Noguchi, Hideko

AU - Hirakata, Hideki

AU - Tsuruya, Kazuhiko

AU - Kitazono, Takanari

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N2 - Background and objectives The risk assessment for developing ESRD remains limited in patients with IgA nephropathy (IgAN). The aim of this study was to develop and validate a prediction rule for estimating the individual risk of ESRD in patients with IgAN. Design, setting, participants, & measurements A total of 698 patients with IgAN diagnosed by renal biopsy at Kyushu University Hospital (derivation cohort) between 1982 and 2010 were retrospectively followed. The Oxford classification was used to evaluate the pathologic lesions. The risk factors for developing ESRD were evaluated using a Cox proportional hazard modelwith a stepwise backward eliminationmethod. The prediction rule was verified using data from 702 patients diagnosed at Japanese Red Cross Fukuoka Hospital (validation cohort) between 1979 and 2002. Results In the derivation cohort, 73 patients developed ESRD during the median 4.7-year follow-up. The final prediction model included proteinuria (hazard ratio [HR], 1.30; 95% confidence interval [95% CI], 1.16 to 1.45, every 1 g/24 hours), estimated GFR (HR, 0.84; 95% CI, 0.74 to 0.96, every 10 ml/min per 1.73 m2), mesangial proliferation (HR, 1.85; 95% CI, 1.10 to 3.11), segmental sclerosis (HR, 3.21; 95% CI, 1.37 to 7.51), and interstitial fibrosis/tubular atrophy (T1:HR, 5.30; 95%CI, 2.63 to 10.7; T2:HR, 20.5; 95%CI, 9.05 to 46.5) as independent risk factors for developing ESRD. To create a prediction rule, the score for each variable was weighted by the regression coefficients calculated using the relevant Cox model. The incidence of ESRD increased linearly with increases in the total risk scores (P for trend <0.001). Furthermore, the prediction rule demonstrated good discrimination (c-statistic=0.89) and calibration (Hosmer-Lemeshow test, P=0.78) in the validation cohort. Conclusions This study developed and validated a new prediction rule using clinical measures and the Oxford classification for developing ESRD in patients with IgAN.

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