02764nas a2200373   4500000000100000008004100001100001700042700001800059700002000077700001700097700002000114700001800134700002000152700002200172700001700194700001700211700001800228700002200246700001300268700001800281700001900299700001800318700001800336700002300354700001600377700002200393700001900415700001600434245013400450300001600584490000700600520176900607022001402376       2018                            d1 aCoresh Josef1 aWoodward Mark1 aBallew Shoshana1 aLevey Andrew1 aHeerspink Hiddo1 aKöttgen Anna1 aEckardt Kai-Uwe1 aHemmelgarn Brenda1 aCarrero Juan1 aGrams Morgan1 aSang Yingying1 aDjurdjev Ognjenka1 aHo Kevin1 aIto Sadayoshi1 aMarks Angharad1 aNaimark David1 aNash Danielle1 aNavaneethan Sankar1 aSarnak Mark1 aStengel Benedicte1 aVisseren Frank1 aWang Angela00aPredicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate.  a1442 - 14510 v933 a<p>Patients with chronic kidney disease and severely decreased glomerular filtration rate (GFR) are at high risk for kidney failure, cardiovascular disease (CVD) and death. Accurate estimates of risk and timing of these clinical outcomes could guide patient counseling and therapy. Therefore, we developed models using data of 264,296 individuals in 30 countries participating in the international Chronic Kidney Disease Prognosis Consortium with estimated GFR (eGFR)s under 30 ml/min/1.73m. Median participant eGFR and urine albumin-to-creatinine ratio were 24 ml/min/1.73mand 168 mg/g, respectively. Using competing-risk regression, random-effect meta-analysis, and Markov processes with Monte Carlo simulations, we developed two- and four-year models of the probability and timing of kidney failure requiring kidney replacement therapy (KRT), a non-fatal CVD event, and death according to age, sex, race, eGFR, albumin-to-creatinine ratio, systolic blood pressure, smoking status, diabetes mellitus, and history of CVD. Hypothetically applied to a 60-year-old white male with a history of CVD, a systolic blood pressure of 140 mmHg, an eGFR of 25 ml/min/1.73mand a urine albumin-to-creatinine ratio of 1000 mg/g, the four-year model predicted a 17% chance of survival after KRT, a 17% chance of survival after a CVD event, a 4% chance of survival after both, and a 28% chance of death (9% as a first event, and 19% after another CVD event or KRT). Risk predictions for KRT showed good overall agreement with the published kidney failure risk equation, and both models were well calibrated with observed risk. Thus, commonly-measured clinical characteristics can predict the timing and occurrence of clinical outcomes in patients with severely decreased GFR.</p>  a1523-1755