Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan

Taku Inohara, Shun Kosaka, Hiroaki Miyata, Ikuko Ueda, Yuichiro Maekawa, Keiichi Fukuda, David J. Cohen, Kevin F. Kennedy, John S. Rumsfeld, John A. Spertus

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background Stratifying patient risk for acute kidney injury (AKI) prior to percutaneous coronary intervention (PCI) can enable clinicians to tailor their approach to minimize AKI. The National Cardiovascular Data Registry (NCDR) CathPCI Registry recently developed 2 prediction models: for AKI and AKI requiring dialysis (AKI-D). Objectives This study sought to externally validate the NCDR AKI and AKI-D models in a Japanese population. Determining the generalizability of the U.S. model could support quality improvement efforts in Japan. Methods The NCDR prediction models were applied to 11,041 consecutive patients in the Japanese multicenter PCI registry. AKI was defined as an absolute increase ≥0.3 mg/dl or a relative increase of 50% in serum creatinine, in accordance with the definition of AKI Network criteria; AKI-D was defined as initiation of dialysis after PCI. Discrimination and calibration of the NCDR models were tested in the Japanese cohort. If the model was perfectly calibrated, the slope and intercept would equal 1.0 and 0.0, respectively. Results In the Japanese PCI cohort, AKI and AKI-D occurred in 10.5% and 1.5% of patients, respectively. The NCDR AKI prediction model showed good discrimination (c-statistic = 0.76) and calibration (slope = 0.93 and intercept = -0.10) in both acute and nonacute PCI. The AKI-D prediction model had good discrimination (c-statistic = 0.92), but while the calibration slope was good (1.04), the intercept was significantly underestimated (0.96). However, this was corrected with recalibration (slope = 1.04 and intercept = -0.087). Conclusions In a Japanese population, the NCDR AKI models validly predict post-procedural AKI and, with recalibration, AKI-D. Prospective use of these models to inform clinical decision making should be tested as a means of reducing AKI after PCI in Japan. (Japan Cardiovascular Database, Percutaneous Coronary Intervention Registry; UMIN R000004736).

Original languageEnglish
Pages (from-to)1715-1722
Number of pages8
JournalJournal of the American College of Cardiology
Volume67
Issue number14
DOIs
Publication statusPublished - 2016 Apr 12

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Keywords

  • external validation
  • percutaneous coronary intervention
  • risk model
  • serum creatinine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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