External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study
Objective Intradialytic hypotension (IDH) is a common and serious complication in patients with Maintenance Hemodialysis (MHD). The purpose of this study is to externally verify three IDH risk prediction models recently developed by Ma et al. and recalibrate, update and present the optimal model to...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2322031 |
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| _version_ | 1832591079713538048 |
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| author | Yuhe Xiang Guoting Ma Qin Yang Min Cao Wenbin Xu Lin Li Qian Yang |
| author_facet | Yuhe Xiang Guoting Ma Qin Yang Min Cao Wenbin Xu Lin Li Qian Yang |
| author_sort | Yuhe Xiang |
| collection | DOAJ |
| description | Objective Intradialytic hypotension (IDH) is a common and serious complication in patients with Maintenance Hemodialysis (MHD). The purpose of this study is to externally verify three IDH risk prediction models recently developed by Ma et al. and recalibrate, update and present the optimal model to improve the accuracy and applicability of the model in clinical environment.Methods A multicenter prospective cohort study of patients from 11 hemodialysis centers in Sichuan Province, China, was conducted using convenience sampling from March 2022 to July 2022, with a follow-up period of 1 month. Model performance was assessed by: (1) Discrimination: Evaluated through the computation of the Area Under Curve (AUC) and its corresponding 95% confidence intervals. (2) Calibration: scrutinized through visual inspection of the calibration plot and utilization of the Brier score. (3) The incremental value of risk prediction and the utility of updating the model were gauged using NRI (Net Reclassification Improvement) and IDI (Integrated Discrimination Improvement). Decision Curve Analysis (DCA) was employed to evaluate the clinical benefit of updating the model.Results The final cohort comprised 2235 individuals undergoing maintenance hemodialysis, exhibiting a 14.6% occurrence rate of IDH. The externally validated Area Under the Curve (AUC) values for the three original prediction models were 0.746 (95% CI: 0.718 to 0.775), 0.709 (95% CI: 0.679 to 0.739), and 0.735 (95% CI: 0.706 to 0.764) respectively. Conversely, the AUC value for the recalibrated and updated columnar plot model reached 0.817 (95% CI: 0.791 to 0.842), accompanied by a Brier score of 0.081. Furthermore, Decision Curve Analysis (DCA) exhibited a net benefit within the threshold probability range of 15.2% to 87.1%.Conclusion Externally validated, recalibrated, updated, and presented IDH prediction models may serve as a valuable instrument for evaluating IDH risk in clinical practice. Furthermore, they hold the potential to guide clinical providers in discerning individuals at risk and facilitating judicious clinical intervention decisions. |
| format | Article |
| id | doaj-art-1c5a495a71a944b281adb14bd3d9a265 |
| institution | Kabale University |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-1c5a495a71a944b281adb14bd3d9a2652025-01-23T04:17:47ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146110.1080/0886022X.2024.2322031External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort studyYuhe Xiang0Guoting Ma1Qin Yang2Min Cao3Wenbin Xu4Lin Li5Qian Yang6School of Nursing, Chengdu Medical College, Chengdu, ChinaHealth Management Center, Sichuan Tai Kang Hospital, Chengdu, ChinaSchool of Nursing, Chengdu Medical College, Chengdu, ChinaDepartment of Orthopedics, Sichuan second traditional Chinese medicine hospital, Chengdu, ChinaSchool of Nursing, Chengdu Medical College, Chengdu, ChinaSchool of Nursing, Chengdu Medical College, Chengdu, ChinaSchool of Nursing, Chengdu Medical College, Chengdu, ChinaObjective Intradialytic hypotension (IDH) is a common and serious complication in patients with Maintenance Hemodialysis (MHD). The purpose of this study is to externally verify three IDH risk prediction models recently developed by Ma et al. and recalibrate, update and present the optimal model to improve the accuracy and applicability of the model in clinical environment.Methods A multicenter prospective cohort study of patients from 11 hemodialysis centers in Sichuan Province, China, was conducted using convenience sampling from March 2022 to July 2022, with a follow-up period of 1 month. Model performance was assessed by: (1) Discrimination: Evaluated through the computation of the Area Under Curve (AUC) and its corresponding 95% confidence intervals. (2) Calibration: scrutinized through visual inspection of the calibration plot and utilization of the Brier score. (3) The incremental value of risk prediction and the utility of updating the model were gauged using NRI (Net Reclassification Improvement) and IDI (Integrated Discrimination Improvement). Decision Curve Analysis (DCA) was employed to evaluate the clinical benefit of updating the model.Results The final cohort comprised 2235 individuals undergoing maintenance hemodialysis, exhibiting a 14.6% occurrence rate of IDH. The externally validated Area Under the Curve (AUC) values for the three original prediction models were 0.746 (95% CI: 0.718 to 0.775), 0.709 (95% CI: 0.679 to 0.739), and 0.735 (95% CI: 0.706 to 0.764) respectively. Conversely, the AUC value for the recalibrated and updated columnar plot model reached 0.817 (95% CI: 0.791 to 0.842), accompanied by a Brier score of 0.081. Furthermore, Decision Curve Analysis (DCA) exhibited a net benefit within the threshold probability range of 15.2% to 87.1%.Conclusion Externally validated, recalibrated, updated, and presented IDH prediction models may serve as a valuable instrument for evaluating IDH risk in clinical practice. Furthermore, they hold the potential to guide clinical providers in discerning individuals at risk and facilitating judicious clinical intervention decisions.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2322031Hemodialysishypotension in dialysisexternal validationprediction modelsprospective study |
| spellingShingle | Yuhe Xiang Guoting Ma Qin Yang Min Cao Wenbin Xu Lin Li Qian Yang External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study Renal Failure Hemodialysis hypotension in dialysis external validation prediction models prospective study |
| title | External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study |
| title_full | External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study |
| title_fullStr | External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study |
| title_full_unstemmed | External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study |
| title_short | External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study |
| title_sort | external validation of the prediction model of intradialytic hypotension a multicenter prospective cohort study |
| topic | Hemodialysis hypotension in dialysis external validation prediction models prospective study |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2024.2322031 |
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