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, Helena Bleken; Read, Stephanie H; Sattar, Naveed; Franzén, Stefan; Halbesma, Nynke; Dorresteijn, Jannick A N; Westerink, Jan; Visseren, Frank L J; Wild, Sarah H; Eliasson, Björn; van der Leeuw, Joep
(2022) Clinical Journal of the American Society of Nephrology, volume 17, issue 12, pp. 1783 - 1791
(Article)
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
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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 m 2) 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.
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Keywords: Diabetes Mellitus, Type 2/complications, Humans, Kidney Transplantation, Renal Dialysis, Renal Insufficiency/epidemiology, Risk Factors, Journal Article
ISSN: 1555-9041
Publisher: American Society of Nephrology
Note: Funding Information: We thank Ann-Marie Svensson (recently deceased) for her keen interest and consistent encouragement during this work. For the Swedish NDR, we thank all of the clinicians who were involved in the care of patients with diabetes for collecting data, and we thank the staff at the Swedish NDR. We acknowledge the contributions of the people and organizations involved in providing data from, setting up, maintaining, and overseeing SCI–Diabetes, including the Scottish Diabetes Research Network supported by the National Health Service (NHS) Research Scotland, a partnership involving Scottish NHS boards and the Chief Scientist Office of the Scottish Government. Funding Information: B. Eliasson reports consultancy agreements with Eli Lilly and Sanofi; honoraria from AstraZeneca, Eli Lilly, Novo Nordisk, and Sanofi; and speakers bureau for AstraZeneca, Novo Nordisk, and Sanofi. B. Eliasson reports personal fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundi-pharma, Navamedic, Novo Nordisk, and RLS Global and grants and personal fees from Sanofi, all outside the submitted work. B. Eliasson is supported by the “Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse.” S. Franzén is an employee of AstraZeneca as of October 4, 2021 and reports ownership interest in AstraZeneca. N. Halbesma is supported by British Heart Foundation Intermediate Basic Science Research Fellowship FS/16/36/32205. S. Read reports employment with, consultancy agreements with, ownership interest in, and research funding from Certara. N. Sattar reports consultancy agreements with Abbott Laboratories, Afimmune, Amgen, AstraZe-neca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi; research funding from AstraZeneca, Boehringer Ingelheim, Novar-tis, and Roche Diagnostics; honoraria from Abbott Laboratories, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, and Novo Nordisk; serving as an associate editor for Circulation and Diabetes Care; serving as an editorial board member of Diabetes & Metabolic Syndrome: Clinical Research and Reviews; serving in an advisory or leadership role for Diabetes UK committees and the European Society of Cardiology Guideline Committee; and serving as a member of the World Heart Federation and the World Obesity Federation. All remaining authors have nothing to disclose. Publisher Copyright: © 2022 by the American Society of Nephrology.
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