Development and validation of a lifetime risk model for kidney failure and treatment benefit in type 2 diabetes: 10-year and lifetime risk prediction models

Østergaard, H. B. et al. (2022) Development and validation of a lifetime risk model for kidney failure and treatment benefit in type 2 diabetes: 10-year and lifetime risk prediction models. Clinical Journal of the American Society of Nephrology, 17(12), pp. 1783-1791. (doi: 10.2215/CJN.05020422) (PMID:36332974)

Abstract

Background and objectives: Individuals with type 2 diabetes are at a higher risk of developing kidney failure. The objective of this study was to develop and validate a decision support tool for estimating 10-year and lifetime risks of kidney failure in individuals with type 2 diabetes as well as estimating individual treatment effects of preventive medication. Design, setting, participants, & measurements: The prediction algorithm was developed in 707,077 individuals with prevalent and incident type 2 diabetes from the Swedish National Diabetes Register for 2002–2019. Two Cox proportional regression functions for kidney failure (first occurrence of kidney transplantation, long-term dialysis, or persistent eGFR <15 ml/min per 1.73 m2) and all-cause mortality as respective end points were developed using routinely available predictors. These functions were combined into life tables to calculate the predicted survival without kidney failure while using all-cause mortality as the competing outcome. The model was externally validated in 256,265 individuals with incident type 2 diabetes from the Scottish Care Information Diabetes database between 2004 and 2019. Results: During a median follow-up of 6.8 years (interquartile range, 3.2–10.6), 8004 (1%) individuals with type 2 diabetes in the Swedish National Diabetes Register cohort developed kidney failure, and 202,078 (29%) died. The model performed well, with c statistics for kidney failure of 0.89 (95% confidence interval, 0.88 to 0.90) for internal validation and 0.74 (95% confidence interval, 0.73 to 0.76) for external validation. Calibration plots showed good agreement in observed versus predicted 10-year risk of kidney failure for both internal and external validation. Conclusions: This study derived and externally validated a prediction tool for estimating 10-year and lifetime risks of kidney failure as well as life years free of kidney failure gained with preventive treatment in individuals with type 2 diabetes using easily available clinical predictors.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Read, Ms Stephanie and Sattar, Professor Naveed
• Authors: Østergaard, H. B., Read, S. H., Sattar, N., Franzén, S., Halbesma, N., Dorresteijn, J. A.N., Westerink, J., Visseren, F. L.J., Wild, S. H., Eliasson, B., and van der Leeuw, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Clinical Journal of the American Society of Nephrology
• Publisher: American Society of Nephrology
• ISSN: 1555-9041
• ISSN (Online): 1555-905X
• Published Online: 04 November 2022
• Copyright Holders: Copyright © 2022 American Society of Nephrology
• First Published: First published in Clinical Journal of the American Society of Nephrology 17(12): 1783-1791
• Publisher Policy: Reproduced in accordance with the publisher copyright policy