Dorte Vistisen1, Gregers S Andersen2, Adam Hulman3, Stuart J McGurnaghan4, Helen M Colhoun4, Jan E Henriksen5, Reimar W Thomsen6, Frederik Persson2, Peter Rossing2,7, Marit E Jørgensen2,8. 1. Steno Diabetes Center Copenhagen, Gentofte, Denmark dorte.vistisen@regionh.dk. 2. Steno Diabetes Center Copenhagen, Gentofte, Denmark. 3. Steno Diabetes Center Aarhus, Aarhus, Denmark. 4. University of Edinburgh, Edinburgh, U.K. 5. Steno Diabetes Center Odense, Odense, Denmark. 6. Aarhus University Hospital, Aarhus, Denmark. 7. University of Copenhagen, Copenhagen, Denmark. 8. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Abstract
OBJECTIVE: End-stage kidney disease (ESKD) is a life-threatening complication of diabetes that can be prevented or delayed by intervention. Hence, early detection of people 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 from 2001 to 2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model on the basis of 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, hemoglobin A1c, smoking, and previous cardiovascular disease. Discrimination was excellent for 5-year risk of an 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, respectively. 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.
OBJECTIVE: End-stage kidney disease (ESKD) is a life-threatening complication of diabetes that can be prevented or delayed by intervention. Hence, early detection of people 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 from 2001 to 2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model on the basis of 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, hemoglobin A1c, smoking, and previous cardiovascular disease. Discrimination was excellent for 5-year risk of an 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, respectively. 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.
Authors: 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 Journal: Diabetes Care Date: 2021-05-20 Impact factor: 17.152
Authors: Julie Aarestrup; Kim Blond; Dorte Vistisen; Marit E Jørgensen; Marie Frimodt-Møller; Britt W Jensen; Jennifer L Baker Journal: PLoS Med Date: 2022-09-21 Impact factor: 11.613