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Abstract
Purpose
Atherosclerosis contributes substantially to cardiovascular mortality in patients with chronic kidney disease (CKD). But precise risk model for subclinical atherosclerosis in the CKD population is still lacking. The study aimed to develop and validate a nomogram for screening subclinical atherosclerosis among CKD patients without dialysis.
Patients and Methods
A total of 1452 CKD stage 1‒5 has been recruited in this cross-sectional study. Subclinical atherosclerosis was diagnosed with carotid ultrasonography. Patients were divided into the training set and validation set. The risk factors of atherosclerosis were identified by the training set and confirmed by the validation set. The receiver operating characteristic (ROC) curves and decision curve analyses (DCA) were executed to evaluate the accuracy of fitted logistic models in training and validation sets. Finally, a nomogram based on constructed logistic regression model in all participants was plotted.
Results
A total of 669 (46.1%) patients were diagnosed with subclinical carotid atherosclerosis. Binary logistic regression analysis showed that males, age, hypertension, diabetes, CKD stages, calcium, platelet, and albumin were risk factors for atherosclerosis. The accuracy of fitted logistic models was evaluated by the area under the ROC curve (AUC), which showed good predictive accuracy in the training set (AUC=0.764 (95% Confidence interval (CI): 0.733–0.794) and validation set (AUC=0.808 (95% CI: 0.765–0.852). A high net benefit was also proven by the DCA. Finally, these predictors were all included to generate the nomogram.
Conclusion
This proposed nomogram shows excellent predictive ability and might have a significant clinical implication for detecting subclinical atherosclerosis in patients with CKD.
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Acknowledgments
We would like to thank all the members of the RETARD cohort study group for their assistance in recruiting participants and data collection. We are grateful to all the participants for their cooperation.
Data Sharing Statement
The data used to support the findings of this study are available from the corresponding author [email protected]) upon request.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards, and was approved of the ethics committee of Xinqiao Hospital (IRB approval number 2018-006-01) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study. Written informed consent was obtained for the publication of patient data.
Author Contributions
X.J.C. prepared and wrote the paper; Y.Z.K. analyzed the data; Z.D.H., H.Y.H., Y.K., collected the data; Z.J.H. conceived the idea of the study; All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.