Original Article
Positive Predictive Value of a Single Assessment of Estimated GFR in the Diagnosis of Chronic Kidney Disease
Abstract
Objectives: The positive predictive value (PPV) of a single assessment of estimated glomerular filtration rate (eGFR) in the diagnosis of chronic kidney disease (CKD) is not known. Our objective was to determine the PPV of a single assessment of eGFR among adults with at least one eGFR <60 mL/min in their lifetime, using the Distributed Area Research and Therapeutics Network CKD natural history dataset.Methods: In all, 47,104 adults who were cared for by 113 practices in the United States were included. Proportions of patients in eGFR categories at baseline were calculated using the following categories: <15 mL/min, 15 to 29.99 mL/min, 30 to 44.99 mL/min, and 45 to 59.99 mL/min. Comparisons were then made between the baseline and the endpoint to identify patients who had a follow-up eGFR that remained at <60 mL/min. The proportions of patients in each eGFR category were compared baseline to endpoint using cross-tabulations. To test the proposed cutpoint, the proportions of patients who had an eGFR that remained at <60 mL/min were measured, using the cutpoints that included the highest cumulative proportion of patients. The sensitivity and specificity of that cutpoint were calculated.
Results: A cutpoint of <45 mL/min was identified, yielding a PPV of 93% with a sensitivity of 28% and a specificity of 94%.
Conclusions: A valid cutpoint to screen for CKD was identified. This cutpoint may prove important to early screening for CKD while reducing the burden on the healthcare system and patients suspected of having CKD.
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References
1. Moyer VA. Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;157:567-570.
2. Qaseem A, Hopkins RH Jr, Sweet DE, et al. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2013;159:835-847.
3. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 2014;63:713-735.
4. Carville S, Wonderling D, Stevens P. Early identification and management of chronic kidney disease in adults: summary of updated NICE guidance. BMJ 2014;349:g4507.
5. Agency for Healthcare Research and Quality. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
6. Poggio ED, Wang X, Greene T, et al. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005;16:459-466.
7. Glassock RJ. Referrals for chronic kidney disease: real problem or nuisance? JAMA 2010;303:1201-1233.
8. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-612.
9. Glassock RJ, Winearls C. Screening for CKD with eGFR: doubts and dangers. Clin J Am Soc Nephrol 2008;3:1563-1568.
10. Eckardt KU, Berns JS, Rocco MV, et al. Definition and classification of CKD: the debate should be about patient prognosisVa position statement from KDOQI and KDIGO. Am J Kidney Dis 2009;53:915-920.
11. Eknoyan G. Kidney disease: wherefore, whence, and whereto? Kidney Int 2007;71:473-475.
12. Eknoyan G, Lameire N, Barsoum R, et al. The burden of kidney disease: improving global outcomes. Kidney Int 2004;66:1310-1314.
13. Glassock RJ, Winearls C. An epidemic of chronic kidney disease: fact or fiction? Nephrol Dial Transplant 2008;23:1117-1121.
14. Rule AD, Rodeheffer RJ, Larson TS, et al. Limitations of estimating glomerular filtration rate from serum creatinine in the general population. Mayo Clin Proc 2006;81:1427-1434.
15. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-S266.
16. Bauer C, Melamed ML, Hostetter TH. Staging of chronic kidney disease: time for a course correction. J Am Soc Nephrol 2008;19:844-846.
17. Glassock RJ, Winearls C. The global burden of chronic kidney disease: how valid are the estimates? Nephron Clin Pract 2008;110:c39-c47.
18. Moynihan R, Glassock R, Doust J. Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased. BMJ 2013;347:f4298.
19. Brown WW, Peters RM, Ohmit SE, et al. Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2003;42:22-35.
20. de Lusignan S, Chan T, Stevens P, et al. Identifying patients with chronic kidney disease from general practice computer records. Fam Pract 2005;22:234-241.
21. Locatelli F, Vecchio LD, Pozzoni P. The importance of early detection of chronic kidney disease. Nephrol Dial Transplant 2002;17(Suppl 11):2-7.
22. Sharma P, McCullough K, Scotland G, et al. Does stage-3 chronic kidney disease matter?: a systematic literature review. Br J Gen Pract 2010;60:e266-e276.
23. O’Hare AM, Choi AI, Bertenthal D, et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol 2007;18:2758-2765.
24. Poggio ED, Rule AD. Can we do better than a single estimated GFR threshold when screening for chronic kidney disease? Kidney Int 2007;72:534-536.
