Shimin Jiang1, Tianyu Yu2, Zheng Zhang2, Jinying Fang3, Yining Wang4, Yue Yang5, Lin Liu5, Guming Zou5, Hongmei Gao5, Li Zhuo5, Wenge Li6. 1. Department of Nephrology, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China; Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. 2. Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. 3. Beijing University of Chinese Medicine, Beijing 100029, China. 4. Peking University Health Science Center, Beijing 100191, China. 5. Department of Nephrology, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China. 6. Department of Nephrology, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China; Graduate School of Peking Union Medical College, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: wenge_lee2002@126.com.
Abstract
AIMS: Both clinical and pathogenetic markers for accurate prediction of end-stage renal disease in diabetic nephropathy (DN) are lacking. This study aimed to establish an effective prognostic nomogram and a score for renal survival (RS) in biopsy-proven DN. METHODS: Analyses were derived from 110 DN patients who underwent renal biopsy at China-Japan Friendship Hospital between January 2006 and May 2018 with DN as the only glomerular disease diagnosis. The prognostic ability of 34 baseline clinicopathologic parameters was evaluated using univariate and multivariate Cox regression analyses. The predictive accuracy and discriminative ability of the final model were measured using the calibration curve and concordance index (C-index). Internal validation of the model was assessed using bootstrap resampling. RESULTS: Urinary proteinuria excretion, stages of chronic kidney disease, glomerular hyalinosis, and extracapillary hypercellularity were independent prognostic factors for RS, and all were selected into the nomogram. The calibration curve for the probability of survival showed good agreement between the prediction by nomogram and actual observation. The C-index for predicting survival was 0.79 (95% confidence interval (CI) 0.72-0.86). A high C-index value of 0.76 indicated good internal validation. The prognostic score had the potential to delineate two prognosis groups with median RS of 24 and 70 months, respectively. CONCLUSIONS: The proposed nomogram and score provide a useful individualized risk estimate of renal prognosis in patients with DN.
AIMS: Both clinical and pathogenetic markers for accurate prediction of end-stage renal disease in diabetic nephropathy (DN) are lacking. This study aimed to establish an effective prognostic nomogram and a score for renal survival (RS) in biopsy-proven DN. METHODS: Analyses were derived from 110 DN patients who underwent renal biopsy at China-Japan Friendship Hospital between January 2006 and May 2018 with DN as the only glomerular disease diagnosis. The prognostic ability of 34 baseline clinicopathologic parameters was evaluated using univariate and multivariate Cox regression analyses. The predictive accuracy and discriminative ability of the final model were measured using the calibration curve and concordance index (C-index). Internal validation of the model was assessed using bootstrap resampling. RESULTS: Urinary proteinuria excretion, stages of chronic kidney disease, glomerular hyalinosis, and extracapillary hypercellularity were independent prognostic factors for RS, and all were selected into the nomogram. The calibration curve for the probability of survival showed good agreement between the prediction by nomogram and actual observation. The C-index for predicting survival was 0.79 (95% confidence interval (CI) 0.72-0.86). A high C-index value of 0.76 indicated good internal validation. The prognostic score had the potential to delineate two prognosis groups with median RS of 24 and 70 months, respectively. CONCLUSIONS: The proposed nomogram and score provide a useful individualized risk estimate of renal prognosis in patients with DN.