| Title: | Effect of Glomerular Filtration Rate by Different Equations on Prediction Models for End-Stage Renal Disease in Diabetes |
| Journal: | Frontiers in Endocrinology |
| Published: | 3 Jun 2022 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/35721706/ |
| DOI: | https://doi.org/10.3389/fendo.2022.873318 |
| URL: | https://www.frontiersin.org/articles/10.3389/fendo.2022.873318/pdf |
Publication 14008
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Abstract
Background and Objectives: The study aimed to evaluate the performance of a predictive model using the kidney failure risk equation (KFRE) for end-stage renal disease (ESRD) in diabetes and to investigate the impact of glomerular filtration rate (GFR) as estimated by different equations on the performance of the KFRE model in diabetes.</p>
Design Setting Participants and Measurements: A total of 18,928 individuals with diabetes without ESRD history from the UK Biobank, a prospective cohort study initiated in 2006-2010, were included in this study. Modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration (CKD-EPI) or revised Lund-Malmö (r-LM) were used to estimate GFR in the KFRE model. Cox proportional risk regression was used to determine the correlation coefficients between each variable and ESRD risk in each model. Harrell's C-index and net reclassification improvement (NRI) index were used to evaluate the differentiation of the models. Analysis was repeated in subgroups based on albuminuria and hemoglobin A1C (HbA1c) levels.</p>
Results: Overall, 132 of the 18,928 patients developed ESRD after a median follow-up of 12 years. The Harrell's C-index based on GFR estimated by CKD-EPI, MDRD, and r-LM was 0.914 (95% CI = 0.8812-0.9459), 0.908 (95% CI = 0.8727-0.9423), and 0.917 (95% CI = 0.8837-0.9496), respectively. Subgroup analysis revealed that in diabetic patients with macroalbuminuria, the KFRE model based on GFR estimated by r-LM (KFRE-eGFRr-LM) had better differentiation compared to the KFRE model based on GFR estimated by CKD-EPI (KFRE-eGFRCKD-EPI) with a KFRE-eGFRr-LM C-index of 0.846 (95% CI = 0.797-0.894, p = 0.025), while the KFRE model based on GFR estimated by MDRD (KFRE-eGFRMDRD) showed no significant difference compared to the KFRE-eGFRCKD-EPI (KFRE-eGFRMDRD C-index of 0.837, 95% CI = 0.785-0.889, p = 0.765). Subgroup analysis of poor glycemic control (HbA1c >8.5%) demonstrated the same trend. Compared to KFRE-eGFRCKD-EPI (C-index = 0.925, 95% CI = 0.874-0.976), KFRE-eGFRr-LM had a C-index of 0.935 (95% CI = 0.888-0.982, p = 0.071), and KFRE-eGFRMDRD had a C-index of 0.925 (95% CI = 0.874-0.976, p = 0.498).</p>
Conclusions: In adults with diabetes, the r-LM equation performs better than the CKD-EPI and MDRD equations in the KFRE model for predicting ESRD, especially for those with macroalbuminuria and poor glycemic control (HbA1c >8.5%).</p>
8 Keywords
- Adult
- Diabetes Mellitus
- Glomerular Filtration Rate
- Glycated Hemoglobin
- Humans
- Kidney Failure, Chronic
- Prospective Studies
- Renal Insufficiency, Chronic
13 Authors
- Liangjing Lv
- Xiangjun Chen
- Jinbo Hu
- Jinshan Wu
- Wenjin Luo
- Yan Shen
- Rui Lan
- Xue Li
- Yue Wang
- Ting Luo
- Shumin Yang
- Qifu Li
- Zhihong Wang
1 Application
| Application ID | Title |
|---|---|
| 66536 | Abdominal obesity and Diabetic Kidney Disease: A Mendelian Randomization Study |
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