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Development and Validation of Prediction Models of Adverse Kidney Outcomes in the Population With and Without Diabetes.

TitleDevelopment and Validation of Prediction Models of Adverse Kidney Outcomes in the Population With and Without Diabetes.
Publication TypeJournal Article
Year of Publication2022
AuthorsGrams ME, Brunskill NJ, Ballew SH, Sang Y, Coresh J, Matsushita K, Surapaneni A, Bell S, Carrero JJ, Chodick G, Evans M, Heerspink HJL, Inker LA, Iseki K, Kalra PA, H Kirchner L, Lee BJ, Levin A, Major RW, Medcalf J, Nadkarni GN, Naimark DMJ, Ricardo AC, Sawhney S, Sood MM, Staplin N, Stempniewicz N, Stengel B, Sumida K, Traynor JP, van den Brand J, Wen C-P, Woodward M, Yang JWon, Wang AYee-Moon, Tangri N, Chalmers J, Woodward M, Hsu C-Y, Ricardo AC, Anderson A, Rao P, Feldman H, Chang AR, Ho K, Green J, H Kirchner L, Bell S, Siddiqui M, Palmer C, Shalev V, Chodick G, Stengel B, Metzger M, Flamant M, Houillier P, Haymann J-P, Stempniewicz N, Cuddeback J, Ciemins E, Kovesdy CP, Sumida K, Carrero JJ, Trevisan M, Elinder CGustaf, Wettermark B, Kalra P, Chinnadurai R, Tollitt J, Green D, Coresh J, Ballew SH, Chang AR, Gansevoort RT, Grams ME, Gutierrez O, Konta T, Köttgen A, Levey AS, Matsushita K, Polkinghorne K, Schäffner E, Woodward M, Zhang L, Ballew SH, Chen J, Coresh J, Grams ME, Matsushita K, Sang Y, Surapaneni A, Woodward M
Corporate AuthorsCKD Prognosis Consortium
JournalDiabetes Care
Date Published2022 Sep 01
KeywordsAlbuminuria, Diabetes Mellitus, Glomerular Filtration Rate, Humans, Kidney, Renal Insufficiency, Renal Insufficiency, Chronic

OBJECTIVE: To predict adverse kidney outcomes for use in optimizing medical management and clinical trial design.

RESEARCH DESIGN AND METHODS: In this meta-analysis of individual participant data, 43 cohorts (N = 1,621,817) from research studies, electronic medical records, and clinical trials with global representation were separated into development and validation cohorts. Models were developed and validated within strata of diabetes mellitus (presence or absence) and estimated glomerular filtration rate (eGFR; ≥60 or

RESULTS: There were 17,399 and 24,591 events in development and validation cohorts, respectively. Models predicting ≥40% eGFR decline or kidney failure incorporated age, sex, eGFR, albuminuria, systolic blood pressure, antihypertensive medication use, history of heart failure, coronary heart disease, atrial fibrillation, smoking status, and BMI, and, in those with diabetes, hemoglobin A1c, insulin use, and oral diabetes medication use. The median C-statistic was 0.774 (interquartile range [IQR] = 0.753, 0.782) in the diabetes and higher-eGFR validation cohorts; 0.769 (IQR = 0.758, 0.808) in the diabetes and lower-eGFR validation cohorts; 0.740 (IQR = 0.717, 0.763) in the no diabetes and higher-eGFR validation cohorts; and 0.750 (IQR = 0.731, 0.785) in the no diabetes and lower-eGFR validation cohorts. Incorporating the previous 2-year eGFR slope minimally improved model performance, and then only in the higher-eGFR cohorts.

CONCLUSIONS: Novel prediction equations for a decline of ≥40% in eGFR can be applied successfully for use in the general population in persons with and without diabetes with higher or lower eGFR.

Alternate JournalDiabetes Care
PubMed ID35856507
Grant ListR01DK100446 / DK / NIDDK NIH HHS / United States
/ / National Kidney Foundation /