Global Validation of a Model to Predict Reduced Estimated GFR in People With Type 2 Diabetes Without Diagnosis of CKD

Abstract

IntroductionA UK-developed minimal-resource pre-screening model for predicting reduced kidney function amongst people with type 2 diabetes and no diagnosis of chronic kidney disease (stage 3-5) was previously developed. This study aims to evaluate the performance of the model on a global population and assess its adequacy with and without regional adjustment. MethodsA retrospective observational study was performed using data collected in the iCaReMe global registry (NCT03549754) and the DISCOVER study (NCT02322762; NCT02226822). Patients were grouped by their World Health Organization classified region. An estimated glomerular filtration rate (eGFR) below 60 was the marker of reduced kidney function. A regional intercept re-calibration was applied to adjust for regional variation. Discrimination and calibration were evaluated for the UK-developed and re-calibrated models. ResultsA total of 14180 patients (46 countries, 6 regions) were identified with type 2 diabetes, no previous diagnosis of CKD and had a serum creatinine measurement or eGFR recorded. The UK-model underestimated risk when applied globally and was deemed inadequate. The model with regional-adjustment achieved the target sensitivity (80.5%; 95% CI: 78.8% - 82.3%) and demonstrated a relative improvement of 51.5% (95% CI: 48.1% - 55.1%) in the positive predictive value, compared to a screen-all approach. ConclusionsThe regional-adjusted model demonstrated adequate performance globally. Incorporating the model within practice could help clinicians to risk-stratify and prioritise patients at high risk. This could enable improved efficiency via risk-tailored screening, particularly in lower-to-middle income countries.