Development and External Validation of a Nomogram and a Risk Table for Prediction of Type 2 Diabetic Kidney Disease Progression Based on a Retrospective Cohort Study in China
Purpose: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease worldwide. Risk assessment provides information about patient prognosis, contributing to the risk stratification of patients and the rational allocation of medical resources. We aimed to develop a model for individualized prediction of renal function decline in patients with type 2 DKD (T2DKD). Patients and Methods: In a retrospective observational study, we followed 307 T2DKD patients and evaluated the determinants of 1) risk of doubling in serum creatinine (Scr), 2) risk of eGFR<15 mL/min/1.73m(2) using potential risk factors at baseline. A prediction model represented by a nomogram and a risk table was developed using Cox regression and externally validated in another cohort with 206 T2DKD patients. The discrimination and calibration of the prediction model were evaluated by the concordance index (C-index) and calibration curve, respectively. Results: Four predictors were selected to establish the final model: Scr, urinary albumin/creatinine ratio, plasma albumin, and insulin treatment. The nomogram achieved satisfactory prediction performance, with a C-index of 0.791 [95% confidence interval (CI) 0.762-0.820] in the derivation cohort and 0.793 (95% CI 0.746-0.840) in the external validation cohort. Then, all predictors were scored according to their weightings. A risk table with the highest score of 11.5 was developed. The C-index of the risk table was 0.764 (95% CI: 0.731-0.797), which was similar to the external validation cohort (0.763; 95% CI: 0.714-0.812). Additionally, the patients were divided into two groups based on the risk table, and significant differences in the probability of outcome events were observed between the high-risk (score >2) and low-risk (score <= 2) groups in the derivation and external validation cohorts (P < 0.001). Conclusion: The nomogram and the risk table using readily available clinical parameters could be new tools for bedside prediction of renal function decline in T2DKD patients.
机构:
Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Bandos, Andriy I.
;
Rockette, Howard E.
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Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Rockette, Howard E.
;
Song, Tao
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Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Song, Tao
;
Gur, David
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Univ Pittsburgh, Sch Med, Dept Radiol, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Bouchi, Ryotaro
;
Babazono, Tetsuya
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Babazono, Tetsuya
;
Yoshida, Naoshi
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Yoshida, Naoshi
;
Nyumura, Izumi
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Nyumura, Izumi
;
Toya, Kiwako
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Toya, Kiwako
;
Hayashi, Toshihide
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Hayashi, Toshihide
;
Hanai, Ko
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Hanai, Ko
;
Tanaka, Nobue
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Tanaka, Nobue
;
Ishii, Akiko
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Ishii, Akiko
;
Iwamoto, Yasuhiko
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
机构:
Fresenius Med Care Asian Pacific, Clin Res & Sci Affairs, Med Affairs, Hong Kong, Peoples R ChinaNatl Taiwan Univ Hosp, Hsin Chu Biomed Pk Branch, Dept Internal Med, Zhubei City, Taiwan
机构:
Queen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England
Univ Birmingham, Coll Med & Dent Sci, Birmingham, W Midlands, EnglandQueen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England
Cockwell, Paul
;
Fisher, Lori-Ann
论文数: 0引用数: 0
h-index: 0
机构:
Univ Hosp West Indies, Kingston, Jamaica
Univ West Indies, Kingston, JamaicaQueen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England
机构:
Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Bandos, Andriy I.
;
Rockette, Howard E.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Rockette, Howard E.
;
Song, Tao
论文数: 0引用数: 0
h-index: 0
机构:
Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
Song, Tao
;
Gur, David
论文数: 0引用数: 0
h-index: 0
机构:
Univ Pittsburgh, Sch Med, Dept Radiol, Pittsburgh, PA 15261 USAUniv Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA
机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Bouchi, Ryotaro
;
Babazono, Tetsuya
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机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Babazono, Tetsuya
;
Yoshida, Naoshi
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机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Yoshida, Naoshi
;
Nyumura, Izumi
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机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Nyumura, Izumi
;
Toya, Kiwako
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Toya, Kiwako
;
Hayashi, Toshihide
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Hayashi, Toshihide
;
Hanai, Ko
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机构:
Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Hanai, Ko
;
Tanaka, Nobue
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Tanaka, Nobue
;
Ishii, Akiko
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
Ishii, Akiko
;
Iwamoto, Yasuhiko
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Tokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, JapanTokyo Womens Med Univ, Sch Med, Div Nephrol & Hypertens, Ctr Diabet,Dept Med,Shinjuku Ku, Tokyo 1628666, Japan
机构:
Fresenius Med Care Asian Pacific, Clin Res & Sci Affairs, Med Affairs, Hong Kong, Peoples R ChinaNatl Taiwan Univ Hosp, Hsin Chu Biomed Pk Branch, Dept Internal Med, Zhubei City, Taiwan
机构:
Queen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England
Univ Birmingham, Coll Med & Dent Sci, Birmingham, W Midlands, EnglandQueen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England
Cockwell, Paul
;
Fisher, Lori-Ann
论文数: 0引用数: 0
h-index: 0
机构:
Univ Hosp West Indies, Kingston, Jamaica
Univ West Indies, Kingston, JamaicaQueen Elizabeth Hosp, Dept Renal Med, Birmingham B15 2WG, W Midlands, England