The findings from both of these studies are "novel and important," but "much additional work is needed before these approaches can be recommended for routine clinical use," said Dr. Marcello Tonelli and Dr. Braden Manns.
Both studies provide proof of concept for two different methods that might enhance prognostic power, compared with the use of creatinine-estimated GFR alone.
However, it would be premature to introduce the triple-marker approach of Dr. Peralta and colleagues into clinical practice for three reasons: First, their study population was highly selected, so the findings cannot be generalized to other settings until further research is done. Second, current practice includes confirmation of estimated GFR with a second measurement to confirm CKD, and this repeat measurement was not addressed in this study. And third, the use of more stringent estimated GFR criteria to define CKD might attenuate the advantage of the triple-marker method.
It also would be premature to implement the prediction model of Dr. Tangri and colleagues because there were missing data in both the cohort used to develop the models and the validation cohort, and values were imputed for subjects who had incomplete information. More importantly, all the study subjects were already in the care of a nephrologist, so they are not representative of the general population.
"Careful consideration and research will be required to determine whether the benefits [of an eight-variable model] would outweigh its added complexity," they concluded.
Dr. Tonelli is at the University of Alberta, Edmonton. Dr. Manns is at the University of Calgary (Alta.). They were supported by the Alberta Heritage Foundation for Medical Research, by Alberta Health and Wellness, and by the University of Alberta. Dr. Tonelli also is supported by a Government of Canada Research Chair in the optimal treatment of CKD. They reported no financial conflicts of interest. These remarks were taken from their editorial accompanying the two reports (JAMA 2011:305:1593-5).
