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논문분류	춘계학술대회 초록집
제목	External Validation and Recalibration of International Prognostic Models for Chronic Kidney Disease in the KNOW-CKD
저자	Sangjun Lee
출판정보	2026; 2026(1):
키워드	Chronic Kidney Disease, Kidney Failure Prediction, External Validation, Prediction Model, Absolute risk Estimation
초록	Objectives: To evaluate the transportability of the Kidney Failure Risk Equation and KDPredict in the Korean KNOW-CKD cohort and to develop locally refitted models for kidney failure, all-cause mortality, and composite outcomes. Methods: Adults enrolled in phases 1 and 2 of KNOW-CKD were analyzed. After excluding participants with missing outcomes or predictors, baseline estimated glomerular filtration rate below 15 mL/min/1.73 m2, polycystic kidney disease, or missing proteinuria data, 2,871 participants remained. Cox models mirrored the original 4-variable and 8-variable Kidney Failure Risk Equation and 4-variable and 6-variable KDPredict structures. External validation used published coefficients with baseline hazard re-estimated in KNOW-CKD for absolute-risk recalibration. Internal refit models re-estimated coefficients in KNOW-CKD. Performance was assessed using time-dependent area under the curve at 2, 5, and 10 years. Results: For kidney failure, external models showed excellent discrimination, with time-dependent area under the curve values of 0.911-0.954 for Kidney Failure Risk Equation models and 0.914-0.952 for KDPredict models; internally refit models showed similar performance, ranging from 0.918-0.960 and 0.918-0.955, respectively. For all-cause mortality, external discrimination was modest, ranging from 0.650-0.778, but improved after refitting in KNOW-CKD to 0.796-0.834. Composite outcome performance was moderate to strong externally, ranging from 0.723-0.886, and improved further after refitting to 0.780-0.892. Risk-factor directions were largely preserved for kidney failure, whereas coefficient magnitudes differed more substantially for mortality and composite outcomes. Conclusion: International kidney failure models generalized well to Korean patients with chronic kidney disease, whereas mortality and composite outcome prediction required local refitting and recalibration. These findings support population-specific implementation and provide the basis for a Korean absolute-risk prediction tool.
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