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Appraising prediction research: a guide and meta-review on bias and applicability assessment using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)
Ype de Jong,Chava L. Ramspek,Carmine Zoccali,Kitty J. Jager,Friedo W. Dekker,Merel van Diepen
doi : 10.1111/nep.13913
Volume 26, Issue 12 p. 939-947
Over the past few years, a large number of prediction models have been published, often of poor methodological quality. Seemingly objective and straightforward, prediction models provide a risk estimate for the outcome of interest, usually based on readily available clinical information. Yet, using models of substandard methodological rigour, especially without external validation, may result in incorrect risk estimates and consequently misclassification. To assess and combat bias in prediction research the prediction model risk of bias assessment tool (PROBAST) was published in 2019. This risk of bias (ROB) tool includes four domains and 20 signalling questions highlighting methodological flaws, and provides guidance in assessing the applicability of the model. In this paper, the PROBAST will be discussed, along with an in-depth review of two commonly encountered pitfalls in prediction modelling that may induce bias: overfitting and composite endpoints. We illustrate the prevalence of potential bias in prediction models with a meta-review of 50 systematic reviews that used the PROBAST to appraise their included studies, thus including 1510 different studies on 2104 prediction models. All domains showed an unclear or high ROB; these results were markedly stable over time, highlighting the urgent need for attention on bias in prediction research. This article aims to do just that by providing (1) the clinician with tools to evaluate the (methodological) quality of a clinical prediction model, (2) the researcher working on a review with methods to appraise the included models, and (3) the researcher developing a model with suggestions to improve model quality.
Building optimal and sustainable kidney care in low resource settings: The role of healthcare systems
Ikechi G. Okpechi,Aminu K. Bello,Valerie A. Luyckx,Nicola Wearne,Charles R. Swanepoel,Vivekanand Jha
doi : 10.1111/nep.13935
Volume 26, Issue 12 p. 948-960
Healthcare systems in low-income and lower-middle income countries (LLMICs) face significant challenges in the provision of health services, for example, kidney care to the population. Although this is linked to several high-level factors such as poor infrastructure, socio-demographic and political factors, healthcare funding has often been cited as the major reason for the wide gap in availability, accessibility and quality of care between LLMICs and rich countries. With the steady rising incidence and prevalence of kidney diseases globally, as well as cost of care, LLMICs are likely to suffer more consequences of these increases than rich countries and may be unable to meet targets of universal health coverage (UHC) for kidney diseases. As health systems in LLMICs continue to adapt in finding ways to provide access to affordable kidney care, various empirical and evidence-based strategies can be applied to assist them. This review uses a framework for healthcare strengthening developed by the World Health Organization (WHO) to assess various challenges that health systems in LLMICs confront in providing optimal kidney care to their population. We also suggest ways to overcome these barriers and strengthen health systems to improve kidney care in LLMICs.
Traditional medicines prescribed for prevention of COVID-19: Use with caution
Rajeevalochana Parthasarathy,Milly Mathew,Priyanka Koshy,Madhusri Babu,Georgi Abraham
doi : 10.1111/nep.13947
Volume 26, Issue 12 p. 961-964
Acute interstitial nephritis can result due to exposure to any medication, toxins, infections or malignancy. In the midst of this Coronavirus (COVID-19) pandemic, there has been a race for finding remedies to prevent the spread of and control the complications due to Severe Acute Respiratory Syndrome Coronavirus 2. Certain Indian medicinal herb concoctions like kabasura kudineer and nilavembu kudineer are being widely publicized to boost immunity and reduce the risk of developing COVID-19. Little knowledge exists about the adverse effects of these herbal remedies. We report two patients who presented to us with vague complaints following the ingestion of kabasura kudineer and we diagnosed them with acute tubulointerstitial nephritis (ATIN). The temporal relationship of ingestion of these remedies to the development of ATIN calls for vigilance and caution with regular monitoring of renal functions especially in those with chronic kidney disease.
Acute kidney injury in critically ill patients after oncological surgery: Risk factors and 1-year mortality
Bertha M. Córdova-Sánchez,Aranza Joffre-Torres,Emerson Joachín-Sánchez,Luis E. Morales Buenrostro,Silvio A. Ñamendys-Silva
doi : 10.1111/nep.13964
Volume 26, Issue 12 p. 965-971
We aimed to identify risk factors associated with acute kidney injury (AKI) and to analyse 1-year mortality after oncological surgery.
Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre-dialysis chronic kidney disease: A systematic review and meta-analysis
Maria-Eleni Alexandrou,Marieta P. Theodorakopoulou,Afroditi Boutou,Eva Pella,Aristi Boulmpou,Christodoulos E. Papadopoulos,Andreas Zafeiridis,Aikaterini Papagianni,Pantelis Sarafidis
doi : 10.1111/nep.13951
Volume 26, Issue 12 p. 972-980
The burden of several cardiovascular risk factors increases in parallel to renal function decline. Exercise intolerance is common in patients with chronic kidney disease (CKD) and has been associated with increased risk of adverse outcomes. Whether indices of cardiorespiratory capacity deteriorate with advancing CKD stages is unknown.
Physical functioning in patients with chronic kidney disease stage G3b-5 in Japan: The reach-J CKD cohort study
Reiko Okubo,Masahide Kondo,Ryoya Tsunoda,Kei Nagai,Hirayasu Kai,Chie Saito,Junichi Hoshino,Hirokazu Okada,Ichiei Narita,Takashi Wada,Naoki Kashihara,Bruce Robinson,Kunihiro Yamagata
doi : 10.1111/nep.13955
Volume 26, Issue 12 p. 981-987
Chronic kidney disease (CKD) is an important public health problem. Recently, CKD has been found to be associated with poor physical functioning in community-dwelling elderly individuals. However, the physical functioning of non-dialysis (ND) patients with advanced CKD treated by nephrologists is unknown.
Potential determinants of the E/e? ratio in non-dialysis compared with dialysis patients
Hon-Chun Hsu,Gavin R. Norton,Chanel Robinson,Angela J. Woodiwiss,Patrick H. Dessein
doi : 10.1111/nep.13948
Volume 26, Issue 12 p. 988-998
We hypothesized that arterial function and N-terminal natriuretic peptide (NT-proBNP) levels as a marker of volume overload, relate differently to E/e? as an index of diastolic function in dialysis compared with non-dialysis patients with chronic kidney disease. We further examined whether cardiovascular risk factors attenuated these relationships.
Association between conscientiousness and peritoneal dialysis-related peritonitis
Shintaro Komatsu,Takashi Hara,Maki Hiratsuka,Yosuke Yamada
doi : 10.1111/nep.13952
Volume 26, Issue 12 p. 999-1006
Peritonitis is a critical complication in patients undergoing peritoneal dialysis. Patient characteristics, especially conscientiousness, potentially influence self-care activity. This study aimed to examine the relationship between the peritonitis risk and the patient conscientiousness.
Sodium-glucose cotransporter 2 inhibitors for diabetes mellitus control after kidney transplantation: Review of the current evidence
Mehmet Kanbay,Atalay Demiray,Baris Afsar,Kagan E. Karakus,Alberto Ortiz,Mads Hornum,Adrian Covic,Pantelis Sarafidis,Peter Rossing
doi : 10.1111/nep.13941
Volume 26, Issue 12 p. 1007-1017
Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are promising drugs to treat chronic kidney disease patients with or without diabetes mellitus (DM). Besides improving glycemic control, SGLT2i are cardioprotective and kidney protective and decrease bodyweight, serum uric acid, blood pressure, albuminuria and glomerular hyperfiltration. These effects may benefit graft function and survival in kidney transplant (KT) patients. In this review, we evaluate data on the efficacy and safety of SGLT2i for KT patients with DM. Eleven studies with 214 diabetic KT patients treated with SGLT2i have been reported. SGLT2i lowered haemoglobin A1c and bodyweight. While glomerular filtration rate may be reduced in the short-term, it remained similar to baseline after 3–12?months. In two studies, blood pressure decreased and remained unchanged in the others. There were no significant changes in urine protein to creatinine ratio. Regarding safety, 23 patients had urinary tract infections, 2 patients had a genital yeast infection, one had acute kidney injury, and one had mild hypoglycaemia. No cases of ketoacidosis or acute rejection were reported. In conclusion, the limited experience so far suggests that SGLT2i are safe in KT patients with DM, decrease bodyweight and improve glycemic control. However, some of the benefits observed in larger studies in the non-KT population have yet to be demonstrated in KT recipients, including preservation of kidney function, reduction in blood pressure and decreased proteinuria.
Novel gain-of-function mutation of TRPC6 Q134P contributes to late onset focal segmental glomerulosclerosis in a Chinese pedigree
Zhiying Liu,Haiyan Zhang,Shipeng Zhao,Qian Zhang,Ruixiao Zhang,Yue Han,Leping Shao,Xiangzhong Zhao
doi : 10.1111/nep.13963
Volume 26, Issue 12 p. 1018-1025
Focal segmental glomerulosclerosis (FSGS, OMIM®#603?965) is an overriding cause that leads to end-stage renal disease (ESRD). As a member of TRP superfamily, mutations of TRPC6 gene are closely linked to FSGS. By now, 20 missense mutations have been reported, among them, nine gain-of-function (GOF), and five loss-of-function (LOF) mutations have been recognized according to the effect on TRPC6 channel activity. Systematic investigations of functional mutations will provide valuable evidences for understanding the pathophysiology of TRPC6 involved in FSGS. The aim of this study is to investigate the pathogenicity of a novel TRPC6 mutation p.Q134P in FSGS.
Lower baseline eGFR levels and IgA nephropathy prediction tool
Ayse S. Artan,Safak Mirioglu,Erol Demir,Ahmet B. Dirim,Seda Safak,Nurana Garayeva,Yasemin Ozluk,Ozgur A. Oto,Halil Yazici,Yasar K. Caliskan
doi : 10.1111/nep.13934
Volume 26, Issue 12 p. 1026-1027
Ludwig's angina in a kidney transplant recipient
Elen Almeida Romao,Alessandro Xavier Donatti,Maria Fernanda Ali Mere,Carlos Augusto Fernandes Molina,Rodrigo de Carvalho Santana,Miguel Moyses Neto
doi : 10.1111/nep.13940
Volume 26, Issue 12 p. 1027-1028
