The Establishment And Validation Of A Risk Appraisal Model For Diabetic Kidney Disease Based On A Systematic Review And Meta-Analysis

Objectives:Diabetic kidney disease is now the leading cause of end-stage renal disease,it is almost irreversible once progresses to the clinical proteinuria.Therefore,early detection and prevention are critical.This study is designed to establish a risk appraisal model for diabetic kidney disease based on a systematic review and meta-analysis,providing early detection and intervention to patients with type 2 diabetes(T2D)who are at high-risk for diabetic kidney disease to promote health,reduce familial or social medical burden,and lessen the morbidity of diabetic kidney disease.Methods:(1)Systematic review and meta-analysis:we retrieved the relevant studies based on the established retrieval strategy and inclusion or exclusion criteria,retrospecting the onset risk factors for diabetic kidney disease in patients with T2D,and then integrated the risk ratio(RR)of each factor.(2)Establishment of the risk appraisal model for diabetic kidney disease:according to the pooled RR and its corresponding 95%CI,we calculated the regression coefficient and the risk score of each onset risk factor,and established a risk appraisal model for diabetic kidney disease.(3)Validation of the risk appraisal model for diabetic kidney disease:A retrospective cohort consisting of 380 patients with T2D from Tianjin Medical University Metabolic Diseases Hospital was used as validation cohort.By comparing the sensitivity,specificity and area under the ROC curve(AUC),we selected an appropriate predictive cut-off value,conducting risk stratification in patients with T2D.Results:(1)Systematic review and meta-analysis:A total of 20 cohorts were included in our systematic review and meta-analysis.There were 10 risk factors with statistically differences,including age,BMI,smoking,diabetic retinopathy(DR),hemoglobin A1c(HbA1c),systolic blood pressure(SBP),high-density lipoprotein cholesterol(HDL-C),triglyceride(TG),urinary albumin to creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR),the pooled RR of each risk factor was 1.38,1.16,1.49,1.31,1.17,1.21,0.78,1.42,1.13 and 2.20,respectively.(2)The establishment of the risk appraisal model for diabetic kidney disease:eGFR was not included in the model because of a huge heterogeneity among relevant studies.The risk factors and their corresponding scores in the final model were:age(years old,39-49 scores 0 point,50-59 scores 3.0 points,and 60-75 scores 6.0 points),BMI(kg/m~2,<24.00 scores 0point,24.00-27.99 scores 1.5 points,and?28.00 scores 3.0 points),smoking(0 point for non-smoker and 4.0 points for smoker),DR(0 point for no DR and 3.0 points for DR),HbA1c(%,<7.0 scores 0 point,7.0-7.9 scores 1.5 points,8.0-8.9 scores 3.0points,and?9.0 scores 4.5 points),SBP(mmHg,<130 scores 0 point,130-139 scores2.0 points,140-149 scores 4.0 points,and?150 scores 6.0 points),HDL-C(mmol/L,?1.30 scores 0 point and<1.30 scores 2.5 points),TG(mmol/L,<1.70 scores 0 point and?1.70 scores 4.0 points)and UACR(mg/g,<10.00 scores 0 point,10.00-19.99scores 2.0 points,20.00-29.99 scores 4.0 points).(3)The validation of the risk appraisal model for diabetic kidney disease:By comparing the performance of the model in different cut-off values,we selected 16.0 points to distinguish patients with high-risk for diabetic kidney disease.At this cut-off value,the sensitivity,specificity and AUC with its 95%CI were 0.847,0.677 and 0.762(0.709,0.815),respectively.Conclusions:A risk appraisal model for diabetic kidney disease applied to patients with T2D aged from 39 to 75 years old was established based on a systematic review and meta-analysis and was validated in a retrospective cohort study with a good predictive efficacy,which is of great importance in the early detection of patients with high-risk for diabetic kidney disease as well as initiation comprehensive and individualized intervention.