Background: Patients with cardiovascular disease are at an increased risk of chronic kidney disease (CKD). However,\ndata on incident CKD in patients with multiple vascular comorbidities are insufficient. In this study, we identified\nthe predictors of CKD stages 3-5 in patients at risk of cardiovascular disease and used their estimated glomerular\nfiltration rate (eGFR) to construct a nomogram to predict the 5-year risk of incident CKD.\nMethods: Ambulatory data on 622 adults with preserved kidney function and one or more cardiovascular disease\nrisk factors who attended outpatient clinics at a tertiary care hospital in Al-Ain, United Arab Emirates were obtained\nretrospectively. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation and\nassessed every 3 months from baseline to December 12, 2017. Fine and Gray competing risk regression model was\nused to identify the independent variables and construct a nomogram to predict incident CKD at 5 years, which is\ndefined as eGFR < 60 mL/min/1.73m2 for greater than equal to3 months. Time-dependent area under the receiver operating characteristic\ncurve (AUC) was used to evaluate the discrimination ability of the model. Calibration curves were applied to determine\nthe calibration ability and adjusted for the competing risk of death. Internal validation of predictive accuracy\nwas performed using K-fold cross-validation.\nResults: Of the 622 patients, 71 had newly developed CKD stages 3-5 over a median follow-up of 96 months\n(interquartile range, 86-103 months). Baseline eGFR, hemoglobin A1c, total cholesterol, and history of diabetes\nmellitus were identified as significant predictors of CKD stages 3-5. The nomogram had good discrimination\nin predicting the disease stages, with a time-dependent AUC of 0.918 (95% confidence interval, 0.846-0.964)\nat 5 years, after internal validation by cross-validation.\nConclusions: This study demonstrated that incident CKD could be predicted with a simple and practical\nnomogram in patients at risk of cardiovascular disease and with preserved kidney function, which in turn\ncould help clinicians make more informed decisions for CKD management in these patients.
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