Prediction of new onset of end stage renal disease in Chinese patients with type 2 diabetes mellitus - a population-based retrospective cohort study

• Published in: BMC nephrology Vol. 18; no. 1; p. 257
• Main Authors: Wan, Eric Yuk Fai, Fong, Daniel Yee Tak, Fung, Colman Siu Cheung, Yu, Esther Yee Tak, Chin, Weng Yee, Chan, Anca Ka Chun, Lam, Cindy Lo Kuen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.08.2017; BioMed Central; BMC
• Subjects: Age; Aged; Albumin; Analysis; Antihypertensives; Blood pressure; Body mass; Body mass index; China - epidemiology; Cholesterol; Chronic kidney failure; Cohort analysis; Cohort Studies; Creatinine; Development and progression; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Diabetic retinopathy; End stage renal disease; Epidermal growth factor receptors; Female; Gender; Glomerular filtration rate; Health aspects; Health risk assessment; Humans; Hypertension; Insulin; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Kidney transplantation; Laboratories; Male; Middle Aged; Mortality; Nephrology; Patients; Population; Population studies; Population Surveillance - methods; Population-based studies; Prediction; Predictive Value of Tests; Primary care; Primary nursing; Retinopathy; Retrospective Studies; Risk; Risk Factors; Smoking; Sociodemographics; Statistical analysis; Studies; Type 2 diabetes; Type 2 diabetes mellitus; Urine; Risk; Type 2 diabetes mellitus; End stage renal disease; Primary care; Prediction
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-017-0671-x

Since diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD), this study aimed to develop a 5-year ESRD risk prediction model among Chinese patients with Type 2 DM (T2DM) in primary care. A retrospective cohort study was conducted on 149,333 Chinese adult T2DM primary care patients without ESRD in 2010. Using the derivation cohort over a median of 5 years follow-up, the gender-specific models including the interaction effect between predictors and age were derived using Cox regression with a forward stepwise approach. Harrell's C-statistic and calibration plot were applied to the validation cohort to assess discrimination and calibration of the models. Prediction models showed better discrimination with Harrell's C-statistics of 0.866 (males) and 0.862 (females) and calibration power from the plots than other established models. The predictors included age, usages of anti-hypertensive drugs, anti-glucose drugs, and Hemogloblin A1c, blood pressure, urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Specific predictors for male were smoking and presence of sight threatening diabetic retinopathy while additional predictors for female included longer duration of diabetes and quadratic effect of body mass index. Interaction factors with age showed a greater weighting of insulin and urine ACR in younger males, and eGFR in younger females. Our newly developed gender-specific models provide a more accurate 5-year ESRD risk predictions for Chinese diabetic primary care patients than other existing models. The models included several modifiable risk factors that clinicians can use to counsel patients, and to target at in the delivery of care to patients.