A Multifactorial Risk Score System for the Prediction of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus

Abstract

Purpose In-depth investigations of risk factors for the identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) are rare. We aimed to investigate the risk factors for developing DKD from multiple types of clinical data and conduct a comprehensive risk assessment for individuals with diabetes. Methods We carried out a case-control study, enrolling 958 patients to identify the risk factors for developing DKD in T2DM patients from a database established from inpatient electronic medical records. Multivariable logistic regression was applied to develop a prediction model and the performance of the model was evaluated using the area under the curve (AUC) and calibration curve. A multifactorial risk score system was established according to the Framingham Study risk score. Results DKD accounted for 34.03% of eligible patients in total. Twelve risk factors were selected in the final prediction model, including age, duration of diabetes, duration of hypertension, fasting blood glucose, fasting C-peptide, insulin use, systolic blood pressure, low-density lipoprotein, γ-glutamyl transpeptidase, platelet, uric acid, and thyroid stimulating hormone; and one protective factor, serum albumin. The prediction model showed an AUC of 0.862 (95% Confidence Interval (CI) 0.834–0.890) with an accuracy of 81.5% in the derivation dataset and an AUC of 0.876 (95% CI 0.825–0.928) in the validation dataset. The calibration curves were excellent and the estimated probability of DKD was more than 80% when the cumulative score for risk factors reached 17 points. Conclusion Newly recognized risk factors were applied to assess the development of DKD in T2DM patients and the established risk score system was a reliable and feasible tool for assisting clinicians to identify patients at high risk of DKD.

Development of Serum Lactate Level-Based Nomograms for Predicting Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients

“…Several studies have identified hyperglycemia, serum uric acid (SUA), and platelets as risk factors for DKD in DM patients, associating them with increased risk of microalbuminuria, rapid eGFR decline, and progression to end-stage renal disease (ESRD). [36][37][38][39] Our findings in the normal lactate level group corroborated these observations, demonstrating significantly higher blood glucose, SUA, and platelet levels of DKD patients compared to those in T2DM patients without DKD, establishing them as independent risk factors for DKD. Current studies have suggested that hyperglycemia triggers oxidative stress and inflammation through activation of signaling pathways such as NF-κB, PI3K/Akt, and MAPK/ERK, ultimately contributing to DKD pathogenesis.…”

Risk prediction models for diabetic nephropathy among type 2 diabetes patients in China: a systematic review and meta-analysis

“…Subsequent screening of titles and abstracts reduced the pool to 759 articles. After a full-text review, 32 articles were ultimately included in the study ( 16 – 47 ). Figure 2 shows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, illustrating the comprehensive literature screening process and results.…”

“…Among the 32 studies included, 12 were published domestically ( 16 – 25 ), and 20 were published internationally ( 26 – 47 ). The most contributions came from scholars in Jiangsu Province, with a total of seven studies ( 18 , 20 , 28 , 30 , 38 , 40 , 41 ).…”

Association of systemic immune-inflammation index with diabetic kidney disease in patients with type 2 diabetes: a cross-sectional study in Chinese population

“…Evidence to date has suggested that hyperglycaemia, hypertension, dyslipidaemia, and IR are important risk factors for DKD ( 49 , 63 ). Hyperglycemia is a widely accepted modifiable risk factor for the initiation and promotion of DKD through triggering three cardinal and inter-related pathways including overproduction of ROS, activation of apoptotic pathway and initiation of autophagy, especially in people with poor glycemic control ( 64 ). Elevated blood pressure and dyslipidemia were also identified as other major modifiable risk factors associated with the development and progression of DKD in T2DM individuals ( 64 ).…”

“…Hyperglycemia is a widely accepted modifiable risk factor for the initiation and promotion of DKD through triggering three cardinal and inter-related pathways including overproduction of ROS, activation of apoptotic pathway and initiation of autophagy, especially in people with poor glycemic control ( 64 ). Elevated blood pressure and dyslipidemia were also identified as other major modifiable risk factors associated with the development and progression of DKD in T2DM individuals ( 64 ). Some studies have found that antihypertensive and lipid-lowering therapy can reduce the risk of albuminuria, kidney function decline, and progression to ESRD ( 35 , 65 ).…”