Prediction of new onset of end stage renal disease in Chinese patients with type 2 diabetes mellitus – a population-based retrospective cohort study

Abstract

BackgroundSince diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD), this study aimed to develop a 5-year ESRD risk prediction model among Chinese patients with Type 2 DM (T2DM) in primary care.MethodsA retrospective cohort study was conducted on 149,333 Chinese adult T2DM primary care patients without ESRD in 2010. Using the derivation cohort over a median of 5 years follow-up, the gender-specific models including the interaction effect between predictors and age were derived using Cox regression with a forward stepwise approach. Harrell’s C-statistic and calibration plot were applied to the validation cohort to assess discrimination and calibration of the models.ResultsPrediction models showed better discrimination with Harrell’s C-statistics of 0.866 (males) and 0.862 (females) and calibration power from the plots than other established models. The predictors included age, usages of anti-hypertensive drugs, anti-glucose drugs, and Hemogloblin A1c, blood pressure, urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Specific predictors for male were smoking and presence of sight threatening diabetic retinopathy while additional predictors for female included longer duration of diabetes and quadratic effect of body mass index. Interaction factors with age showed a greater weighting of insulin and urine ACR in younger males, and eGFR in younger females.ConclusionsOur newly developed gender-specific models provide a more accurate 5-year ESRD risk predictions for Chinese diabetic primary care patients than other existing models. The models included several modifiable risk factors that clinicians can use to counsel patients, and to target at in the delivery of care to patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0671-x) contains supplementary material, which is available to authorized users.

Spironolactone dose‑dependently alleviates the calcification of aortic rings cultured in hyperphosphatemic medium with or without hyperglycemia by suppressing phenotypic transition of VSMCs through downregulation of Pit‑1

“…Previously, human aortic smooth muscle cells were cultured in hyperglycemic and hyperphosphatemic media, and the combined effects of hyperphosphatemia and hyperglycemia were also observed on human aortic smooth muscle cell calcification (34). Regarding the above-mentioned results, it was concluded that there were combined effects of hyperglycemia and hyperphosphatemia on VSMC calcification, and it is considered to be a key explanation for why ESRD patients with diabetes mellitus exhibted shorter survival times/higher mortality rate (35–37). In addition, it was noticed that calcification in 30 mM glucose (HG) was more significant than in 2.5 mM Pi.…”

Development of model to predict end-stage renal disease after coronary artery bypass grafting

“…Prediction models for ESRD have been evaluated in patients with various pathologic conditions, such as CKD, [23–26] light chain amyloidosis, [27] and diabetes. [28–31] Nevertheless, an ESRD-prediction model after CABG has never been developed. The Cleveland Clinic score and the Society of Thoracic Surgery risk score have a limitation in predicting a risk of ESRD over several years.…”

Combined effects of hyperphosphatemia and hyperglycemia on the calcification of cultured human aortic smooth muscle cells

“…It is unclear what occurs when hyperphosphatemia and hyperglycemia are present at the same time; however, these are likely to be the conditions that occur in patients with diabetic kidney disease (DKD) (17). It is well established that CKD patients with hyperglycemia have a shorter survival time and/or higher mortality rate (21,22). Yoshida et al (23) incubated rat and human aortic SMCs with various concentrations of phosphate and glucose, and demonstrated that calcium accumulation is increased by high phosphate concentration in a dose-dependent manner, but not by high glucose concentration.…”