Modified CKD model aids risk prediction in African Americans

By Sally Robertson, B.Sc.Dec 7 2012

Screening African Americans for microalbuminuria at either 5- or 10-year intervals would be highly cost-effective using a modified version of the CKD [chronic kidney disease] Health Policy Model, US researchers report.

Although the previous model accurately predicts CKD prevalence and the cumulative incidence of end-stage renal disease (ESRD) in the overall US population, it is not reliable for predicting ESRD risk among African Americans, who have a similar or lower prevalence of CKD relative to other racial groups, but a significantly higher lifetime incidence of ESRD.

As reported in the Journal of the American Society of Nephrology, Thomas Hoerger (Research Triangle Institute International, North Carolina) and colleagues adapted the model to reflect the variations in prevalence of diabetes, hypertension, and elevated albuminuria by race.

However, although race-specific differences in these risk factors influenced the relative rate of progression of CKD in African Americans, it did not account for the increased incidence of lifetime ESRD in this population.

The team decided to calibrate the model to effectively accelerate CKD progression among African Americans with CKD, applying a 20% increase in the rate of glomerular filtration rate (GFR) decline at CKD stage 3 and a 60% increase in the rate of GFR decline at stage 4.

Incorporating faster progression of CKD among African Americans during the later stages of disease led to a model that closely reflected the lifetime incidence of ESRD in this population, as given by the US Renal Data System.

Cost analysis showed that compared with usual care, screening African Americans at 10, 5-, 2-, and 1-year intervals with the model was associated with an incremental cost-effectiveness ratio of US$ 9000 (€ 6880), US$ 11,000 (€ 8410), US$ 19,000 (€ 14,530), and US$ 35,000 (€ 26,760) per quality-adjusted life year, respectively.

The researchers report that ESRD incidence decreased by negligible amounts with screening intervals of less than 5 years. However, "part of the beneficial effect of screening is not total avoidance of ESRD, but a delay in ESRD onset," they say.

Therefore, the team concludes that screening would be highly cost-effective among African Americans if it were carried out every 5 to 10 years.

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