scholarly journals A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes

2021 ◽  
Author(s):  
Dorte Vistisen ◽  
Gregers S. Andersen ◽  
Adam Hulman ◽  
Stuart J. McGurnaghan ◽  
Helen M. Colhoun ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
Clinical Decision Making ◽  
External Validation ◽  
End Stage Kidney Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
End Stage

<b>OBJECTIVE </b> <p>End-stage kidney disease (ESKD) is a life-threatening complication of diabetes which can be prevented or delayed by intervention. Hence, early detection of persons at increased risk is essential.</p> <p> </p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>From a population-based cohort of 5,460 clinically diagnosed Danish adults with type 1 diabetes followed 2001-2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model based on 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.</p> <p> </p> <p><b>RESULTS</b> </p> <p>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, HbA<sub>1c</sub>, smoking and previous cardiovascular disease. Discrimination was excellent for 5-year risk of 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. </p> <p> </p> <p><b>CONCLUSIONS</b> </p> <p>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.</p>

scholarly journals A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes

2021 ◽  
Author(s):  
Dorte Vistisen ◽  
Gregers S. Andersen ◽  
Adam Hulman ◽  
Stuart J. McGurnaghan ◽  
Helen M. Colhoun ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
Clinical Decision Making ◽  
External Validation ◽  
End Stage Kidney Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
End Stage

<b>OBJECTIVE </b> <p>End-stage kidney disease (ESKD) is a life-threatening complication of diabetes which can be prevented or delayed by intervention. Hence, early detection of persons at increased risk is essential.</p> <p> </p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>From a population-based cohort of 5,460 clinically diagnosed Danish adults with type 1 diabetes followed 2001-2016, we developed a prediction model for ESKD accounting for the competing risk of death. Poisson regression analysis was used to estimate the model based on 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.</p> <p> </p> <p><b>RESULTS</b> </p> <p>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, HbA<sub>1c</sub>, smoking and previous cardiovascular disease. Discrimination was excellent for 5-year risk of 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. </p> <p> </p> <p><b>CONCLUSIONS</b> </p> <p>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.</p>

scholarly journals A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes. Diabetes Care 2021;44:901–907

Diabetes Care ◽  
2021 ◽  
pp. dci210010
Author(s):  
Dorte Vistisen ◽  
Gregers S. Andersen ◽  
Adam Hulman ◽  
Stuart J. McGurnaghan ◽  
Helen M. Colhoun ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
Diabetes Care ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes. Diabetes Care 2021;44:901–907

Diabetes Care ◽  
2021 ◽  
pp. dc210364
Author(s):  
Helena Bleken Østergaard ◽  
Joep van der Leeuw ◽  
Frank L.J. Visseren ◽  
Jan Westerink
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
Diabetes Care ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals A Validated Prediction Model for End-Stage Kidney Disease in Type 1 Diabetes

Diabetes Care ◽  
2021 ◽  
pp. dc202586
Author(s):  
Dorte Vistisen ◽  
Gregers S. Andersen ◽  
Adam Hulman ◽  
Stuart J. McGurnaghan ◽  
Helen M. Colhoun ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Prediction Model ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals External validation and clinical utility of a prediction model for 6-month mortality in patients undergoing hemodialysis for end-stage kidney disease

2017 ◽  
Vol 32 (2) ◽  
pp. 395-403 ◽  
Author(s):  
Brian Forzley ◽  
Lee Er ◽  
Helen HL Chiu ◽  
Ognjenka Djurdjev ◽  
Dan Martinusen ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Prediction Model ◽  
Clinical Utility ◽  
External Validation ◽  
End Stage Kidney Disease ◽  
End Stage

1615-P: Predicting End-Stage Kidney Disease in Type 1 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1615-P
Author(s):  
DORTE VISTISEN ◽  
GREGERS S. ANDERSEN ◽  
ADAM HULMAN ◽  
STUART MCGURNAGHAN ◽  
HELEN M. COLHOUN ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage

Association of Coding Variants in Hydroxysteroid 17-beta Dehydrogenase 14 (HSD17B14) with Reduced Progression to End Stage Kidney Disease in Type 1 Diabetes

2021 ◽  
pp. ASN.2020101457
Author(s):  
Josyf Mychaleckyj ◽  
Erkka Valo ◽  
Takaharu Ichimura ◽  
Tarunveer Ahluwalia ◽  
Christian Dina ◽  
...  
Keyword(s):  
Gene Expression ◽  
Type 1 Diabetes ◽  
Kidney Disease ◽  
Rare Variants ◽  
Disease Stage ◽  
End Stage Kidney Disease ◽  
Gene And Protein Expression ◽  
End Stage ◽  
Coding Variants

Background: Rare variants in gene coding regions likely have a greater impact on disease-related phenotypes than common variants through disruption of their encoded protein. We searched for rare variants associated with onset of end stage kidney disease (ESKD) in individuals with type 1 diabetes at advanced kidney disease stage. Methods: Gene-based exome array analysis of 15,449 genes in 5 large incidence cohorts of individuals with type 1 diabetes and proteinuria were analyzed for survival time-to-ESKD, testing the top gene in a 6th cohort (N=2,372/1,115 events all cohorts) and replicating in two retrospective case-control studies (N=1,072 cases, 752 controls). Deep resequencing of the top associated gene in 5 cohorts confirmed the findings. We performed immunohistochemistry and gene expression experiments in human control and diseased cells, and in mouse ischemia reperfusion and aristolochic acid nephropathy models. Results: Protein coding variants in the hydroxysteroid 17-beta dehydrogenase 14 gene (HSD17B14), predicted to affect protein structure, had a net protective effect against development of ESKD at exome-wide significance (N=4,196; p-value=3.3x10-7). The HSD17B14 gene and encoded enzyme were robustly expressed in healthy human kidney, maximally in proximal tubular cells. Paradoxically, gene and protein expression were attenuated in human diabetic proximal tubules and in mouse kidney injury models. Expressed HSD17B14 gene and protein levels remained low without recovery after 21 days in a murine ischemic reperfusion injury model. Decreased gene expression was found in other chronic kidney disease-associated renal pathologies. Conclusions: HSD17B14 gene is mechanistically involved in diabetic kidney disease. The encoded sex steroid enzyme is a druggable target, potentially opening a new avenue for therapeutic development.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease

2020 ◽  
Author(s):  
Roberto Minutolo ◽  
Carlo Garofalo ◽  
Paolo Chiodini ◽  
Filippo Aucella ◽  
Lucia Del Vecchio ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Endpoint ◽  
End Stage Kidney Disease ◽  
Short Acting ◽  
Erythropoiesis Stimulating Agents ◽  
Increased Risk ◽  
Significant Difference ◽  
Long Acting ◽  
End Stage

Abstract Background Despite the widespread use of erythropoiesis-stimulating agents (ESAs) to treat anaemia, the risk of adverse outcomes associated with the use of different types of ESAs in non-dialysis chronic kidney disease (CKD) is poorly investigated. Methods From a pooled cohort of four observational studies, we selected CKD patients receiving short-acting (epoetin α/β; n = 299) or long-acting ESAs (darbepoetin and methoxy polyethylene glycol-epoetin β; n = 403). The primary composite endpoint was end-stage kidney disease (ESKD; dialysis or transplantation) or all-cause death. Multivariable Cox models were used to estimate the relative risk of the primary endpoint between short- and long-acting ESA users. Results During follow-up [median 3.6 years (interquartile range 2.1–6.3)], the primary endpoint was registered in 401 patients [166 (72%) in the short-acting ESA group and 235 (58%) in the long-acting ESA group]. In the highest tertile of short-acting ESA dose, the adjusted risk of primary endpoint was 2-fold higher {hazard ratio [HR] 2.07 [95% confidence interval (CI) 1.37–3.12]} than in the lowest tertile, whereas it did not change across tertiles of dose for long-acting ESA patients. Furthermore, the comparison of ESA type in each tertile of ESA dose disclosed a significant difference only in the highest tertile, where the risk of the primary endpoint was significantly higher in patients receiving short-acting ESAs [HR 1.56 (95% CI 1.09–2.24); P = 0.016]. Results were confirmed when ESA dose was analysed as continuous variable with a significant difference in the primary endpoint between short- and long-acting ESAs for doses &gt;105 IU/kg/week. Conclusions Among non-dialysis CKD patients, the use of a short-acting ESA may be associated with an increased risk of ESKD or death versus long-acting ESAs when higher ESA doses are prescribed.

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