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

Helena Bleken Østergaard, Stephanie H Read, Naveed Sattar, Stefan Franzén, Nynke Halbesma, Jannick A N Dorresteijn, Jan Westerink, Frank L J Visseren, Sarah H Wild, Björn Eliasson, Joep van der Leeuw

Research output: Contribution to journalArticleAcademicpeer-review

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 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.

Original languageEnglish
Pages (from-to)1783-1791
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume17
Issue number12
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Diabetes Mellitus, Type 2/complications
  • Humans
  • Kidney Transplantation
  • Renal Dialysis
  • Renal Insufficiency/epidemiology
  • Risk Factors

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