Establishment and Validation of a Risk Prediction Model for Early Diabetic Kidney Disease Based on a Systematic Review and Meta-Analysis of 20 Cohorts

Abstract

Identifying patients at high risk of diabetic kidney disease (DKD) helps improve clinical outcome. PURPOSETo establish a model for predicting DKD. DATA SOURCESThe derivation cohort was from a meta-analysis. The validation cohort was from a Chinese cohort. STUDY SELECTIONCohort studies that reported risk factors of DKD with their corresponding risk ratios (RRs) in patients with type 2 diabetes were selected. All patients had estimated glomerular filtration rate (eGFR) ‡60 mL/min/1.73 m 2 and urinary albumin-tocreatinine ratio (UACR) <30 mg/g at baseline. DATA EXTRACTIONRisk factors and their corresponding RRs were extracted. Only risk factors with statistical significance were included in our DKD risk prediction model. DATA SYNTHESISTwenty cohorts including 41,271 patients with type 2 diabetes were included in our meta-analysis. Age, BMI, smoking, diabetic retinopathy, hemoglobin A 1c , systolic blood pressure, HDL cholesterol, triglycerides, UACR, and eGFR were statistically significant. All these risk factors were included in the model except eGFR because of the significant heterogeneity among studies. All risk factors were scored according to their weightings, and the highest score was 37.0. The model was validated in an external cohort with a median follow-up of 2.9 years. A cutoff value of 16 was selected with a sensitivity of 0.847 and a specificity of 0.677. LIMITATIONSThere was huge heterogeneity among studies involving eGFR. More evidence is needed to power it as a risk factor of DKD. CONCLUSIONSThe DKD risk prediction model consisting of nine risk factors established in this study is a simple tool for detecting patients at high risk of DKD.

Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study

“…We developed a points-based risk-scoring tool based on the final model for easy clinical use-a widely utilized method of clinical scoring [23]. This clinical risk prediction tool can be used to identify individuals who are at high risk of developing KOA during the following 4 years.…”

“…Several studies have developed prediction models based on genomic data [18][19][20][21] or radiographic/clinical biomarkers [22] such as hip α-angle and spinal bone mineral density. However, use of these models is limited due to their high cost or complexity [23].…”

Clinical Features of And Risk Factors for Normoalbuminuric Diabetic Kidney Disease In Hospitalized Patients With Type 2 Diabetes Mellitus: A Retrospective Cross-Sectional Study

“…Previous research has shown that a good correlation exists between reduced eGFR and albuminuria in some patients with DKD, whereas recent studies have revealed that the progress of albuminuria, which cannot fully re ect the impairment of renal function, is not synchronous with reduced eGFR, which might lead to DKD through a different pathogenesis [2,42,43]. First, during DKD pathogenesis, a proportion of patients with a rapid eGFR decline exhibited a normoalbuminuria, which might be related to ischemic renal changes caused by atherosclerosis of the intrarenal arteries [39].…”

“…Being the most common microvascular complication of diabetes mellitus (DM), diabetic kidney disease (DKD) is presently the leading cause of end-stage renal disease [1]. In the past, the main indicator for the diagnosis of and treatment for DKD was albuminuria, which was quanti ed by urinary albumin-tocreatinine ratio (UACR); however, this belief has been challenged recently [2]. In 2019, the American Diabetes Association (ADA) stated that a clinical diagnosis of DKD is usually made on the basis of the presence of albuminuria and/or reduced estimated glomerular ltration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage [3], which is consistent with the 2019 Chinese clinical practice guidelines for DKD [4].…”

Poor Control of Plasma Triglycerides Is Associated with Early Decline of Estimated Glomerular Filtration Rates in New-Onset Type 2 Diabetes in China: Results from a 3-Year Follow-Up Study

“…DKD has been the most common cause of ESRD in Western countries, and numerous risk factors have been identified for its progression, including but not limited to older age, smoking, alcohol consumption, overweight/obesity, hyperglycemia, hypertension, dyslipidemia, and hyperuricemia [ 4 , 17 , 18 ]. However, even under strict control of body weight, blood glucose, and blood pressure, some patients still progress to ESRD.…”