title: Development and validation of a predictive model for Chronic Kidney Disease progression in Type 2 Diabetes Mellitus based on a 13-year study in Singapore.
abstract: OBJECTIVE
  This study aims to develop and validate a predictive model for Chronic Kidney Disease (CKD) progression in Type 2 Diabetes Mellitus (T2DM).
  
  
  METHODS
  We conducted a prospective study on 1582 patients with T2DM from a Diabetes Centre in regional hospital in 2002-2014. CKD progression was defined as deterioration across eGFR categories with ⩾25% drop from baseline. The dataset was randomly split into development (70%) and validation (30%) datasets. Stepwise multivariable logistic regression was used to identify baseline predictors for model development. Model performance in the two datasets was assessed.
  
  
  RESULTS
  During median follow-up of 5.5years, 679 (42.9%) had CKD progression. Progression occurred in 467 (42.2%) and 212 patients (44.6%) in development and validation datasets respectively. Systolic blood pressure, HbA1c, estimated glomerular filtration rate and urinary albumin-to-creatinine ratio were associated with progression. Areas under receiving-operating-characteristics curve for the training and test datasets were 0.80 (95%CI, 0.77-0.83) and 0.83 (95%CI, 0.79-0.87). Observed and predicted probabilities by quintiles were not statistically different with Hosmer-Lemeshow χ20.65 (p=0.986) and 1.36 (p=0.928) in the two datasets. Sensitivity and specificity were 71.4% and 72.2% in development dataset, and 75.6% and 72.3% in the validation dataset.
  
  
  CONCLUSIONS
  A model using routinely available clinical measurements can accurately predict CKD progression in T2DM.
authors.affiliation: Khoo Teck Puat Hospital, Clinical Research Unit, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: low.serena.km@alexandrahealth.com.sg.
authors.forename: Serena
authors.initials: S
authors.lastname: Low
authors.affiliation: Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: lim.su.chi@alexandrahealth.com.sg.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Khoo Teck Puat Hospital, Clinical Research Unit, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: zhang.xiao@alexandrahealth.com.sg.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Khoo Teck Puat Hospital, Clinical Research Unit, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: zhoushiyi@genomics.cn.
authors.forename: Shiyi
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Khoo Teck Puat Hospital, Department of General Medicine, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: yeoh.lee.ying@alexandrahealth.com.sg.
authors.forename: Lee Ying
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Khoo Teck Puat Hospital, Department of General Medicine, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: liu.allen.yl@alexandrahealth.com.sg.
authors.forename: Yan Lun
authors.initials: YL
authors.lastname: Liu
authors.affiliation: Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: subramaniam.tavintharan@alexandrahealth.com.sg.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: sum.chee.fang@alexandrahealth.com.sg.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D012307:Risk Factors; D012846:Singapore
keywords: Chronic kidney disease; Diabetes mellitus; Progression