NCDR Prediction Models For Kidney Injury Following PCI Hold up in Japan
Models developed by the ACC’s CathPCI Registry to predict the likelihood of percutaneous coronary intervention (PCI) patients developing acute kidney injury and acute kidney injury requiring dialysis have proven to be effective among patients in Japan, suggesting that these models may have international application as a preventive tool, according to a study published April 4 in the Journal of the American College of Cardiology.
The prediction models from the CathPCI Registry were applied to records from 11,041 patients from the Japan Cardiovascular Database, a registry comprised of 16 centers, between September 2008 and May 2014. The acute kidney injury model used 11 variables for predicting this complication, and the acute kidney model involving dialysis used five variables.
Researchers found 10.1 percent of the patients experienced acute kidney injury and 1.5 percent had a kidney injury that required dialysis. Overall, the prediction model for acute kidney injury performed well. In the highest-risk group, the predicted incidence of acute kidney injury was 34 percent, compared to a 36 percent actual occurrence of the problem.
For patients with acute kidney injury requiring dialysis, the predicted risk was 4 percent, compared to a 9 percent observed incidence. This discrepancy showed that the model underestimated the risk of dialysis among the highest-risk patients. Once the model was adjusted properly, it was better able to stratify risk.
Taku Inohara, MD, the study’s lead author, said that “these findings support the use of the NCDR models in Japan” and pointed out that knowing a patient’s risk for acute kidney injury enables the provider to tailor treatment accordingly.
In an accompanying editorial, Peter A. McCullough, MD, MPH, FACC, said that the study is “an excellent example of how the NCDR can be used to generate meaningful tools for prediction of complications that are set up for external validation from populations outside of the U.S.” He adds that because there are increasing numbers of patients with advanced kidney disease undergoing PCI, “there is an urgent need for safer approaches for these high-risk patients.”
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