Credit: Original article published here.
There is an association between type 2 diabetes and a higher risk of developing kidney failure. Helena Bleken Østergaard, MD, and colleagues conducted a study designed to develop and validate a decision support tool to aid in estimating the 10-year and lifetime risks among individuals with type 2 diabetes of developing kidney failure. The researchers also sought to examine individual treatment effects of preventive medication in that patient population. Results were reported in the Clinical Journal of the American Society of Nephrology [2022;17(12):1783-1791].
The researchers utilized data from the Swedish National Diabetes Register for 2002-2019 on 707,077 individuals with prevalent and incident type 2 diabetes to develop the prediction algorithm. Kidney failure was defined as the first occurrence of kidney transplantation, long-term dialysis, or persistent estimated glomerular filtration rate <15 mL/min/1.73 m2. Using routinely available predictors, two Cox proportional regression functions for kidney failure and all-cause mortality as respective end points were developed. The functions were combined into life tables to calculate the predicted survival without kidney failure while using all-cause mortality as the competing outcome. A cohort of 256,265 individuals with incident type 2 diabetes from the Scottish Care Information Database between 2004 and 2019 was used to externally validate the model.
Median follow-up was 6.8 years. During follow-up 8004 (1%) individuals with type 2 diabetes in the Swedish register developed kidney failure, and 202,078 (29%) died. The model performed well, with c statistics for kidney failure of 0.89 (95% CI, 0.88-0.90) for internal validation and 0.74 (95% CI, 0.73-0.76) for external validation. Results of calibration plots showed good agreement in observed versus predicted 10-year risk of kidney failure in both the internal and external validation models.
“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,” the researchers said.
