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A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes

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posted on 28.01.2021, 10:14 by Dorte Vistisen, Gregers S. Andersen, Adam Hulman, Stuart J. McGurnaghan, Helen M. Colhoun, Jan E. Henriksen, Reimar W. Thomsen, Frederik Persson, Peter Rossing, Marit E. Jørgensen
OBJECTIVE

End-stage kidney disease (ESKD) is a life-threatening complication of diabetes which can be prevented or delayed by intervention. Hence, early detection of persons at increased risk is essential.

RESEARCH DESIGN AND METHODS

From a population-based cohort of 5,460 clinically diagnosed Danish adults with type 1 diabetes followed 2001-2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model based on information routinely collected from clinical examinations. The effect of including an extended set of predictors (lipids, alcohol intake etc.) was further evaluated, and potential interactions identified in a survival tree analysis were tested. The final model was externally validated in 9,175 adults from Denmark and Scotland.

RESULTS

During a median follow-up of 10.4 years (interquartile limits: 5.1;14.7), 303 (5.5%) of the participants (mean (SD) age 42.3 (16.5) years) developed ESKD and 764 (14.0%) died without having developed ESKD. The final ESKD prediction model included age, male sex, diabetes duration, estimated glomerular filtration rate, micro- and macroalbuminuria, systolic blood pressure, HbA1c, smoking and previous cardiovascular disease. Discrimination was excellent for 5-year risk of ESKD event with a C-statistic of 0.888 (95%CI: 0.849;0.927) in the derivation cohort and confirmed at 0.865 (0.811;0.919) and 0.961 (0.940;0.981) in the external validation cohorts from Denmark and Scotland.

CONCLUSIONS

We have derived and validated a novel, high-performing ESKD prediction model for risk stratification in the adult type 1 diabetes population. This model may improve clinical decision making and potentially guide early intervention.

Funding

The Steno Diabetes Centers (Aarhus and Copenhagen) are partially funded by an unrestricted donation from the Novo Nordisk Foundation.

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