# Identifying individuals at risk of needing CKD associated medications in a European kidney disease cohort

## TL;DR

This study identifies patient characteristics that predict the need for CKD-related medications, potentially allowing for less frequent follow-ups in low-risk individuals.

## Contribution

The study introduces a predictive model for CKD medication use based on patient data from a multi-country European cohort.

## Key findings

- Age, diabetes status, and lab values predicted ESA and phosphate binder use with C-statistics of 0.70 and 0.73.
- Sixteen percent of patients had a less than 20% likelihood of needing CKD medications.
- Model performance was consistent across derivation and validation cohorts.

## Abstract

The consequences of chronic kidney disease (CKD) can be addressed with a range of pharmacotherapies primarily prescribed by nephrologists. More accurate information regarding future CKD-related pharmacotherapy requirements could guide clinical decisions including follow-up frequency.

Following assignment to derivation and validation groups (2,1), variables predicting individually future use of vitamin D receptor agonists (VDRA), phosphate binders, erythropoiesis stimulating agents (ESAs) and iron were identified using logistic regression in a prospective cohort study containing demography, comorbidity, hospitalization, laboratory, and mortality data in patients with CKD stage G4/G5 across six European countries. Discriminative ability was measured using C-statistics, and predicted probability of medication use used to inform follow-up frequency.

A total of 2196 patients were included in the analysis. During a median follow-up of 735 days 648 initiated hemodialysis and 1548 did not. Combinations of age, diabetes status and iPTH, calcium, hemoglobin and serum albumin levels predicted the use of ESA, iron, phosphate binder or VDRA, with C-statistics of 0.70, 0.64, 0.73 and 0.63 in derivation cohorts respectively. Model performance in validation cohorts were similar. Sixteen percent of patients were predicted to have a likelihood of receiving any of these medications of less than 20%.

In a multi-country CKD cohort, prediction of ESA and phosphate binder use over a two-year period can be made based on patient characteristics with the potential to reduce frequency of follow-up in individuals with low risk for requiring these medications.

The online version contains supplementary material available at 10.1186/s12882-024-03497-y.