1615-P: Predicting End-Stage Kidney Disease in Type 1 Diabetes
Authors: VISTISEN DORTE , ANDERSEN GREGERS S. , HULMAN ADAM , MCGURNAGHAN STUART , COLHOUN HELEN M. , HENRIKSEN JAN ERIK , THOMSEN REIMAR W. , PERSSON FREDERIK , ROSSING PETER , JØRGENSEN MARIT E. 
Published: June 2020

Introduction: End-stage kidney disease (ESKD) is a life-threatening but preventable complication to diabetes and early detection of high-risk persons is essential. Our aim was to develop a prediction model for ESKD in type 1 diabetes (T1D).

Materials and Methods: Detailed clinical- and lifestyle data from 5,460 Danish adults with T1D was linked to ESKD events and death recorded in the national registries. Median follow-up time was 10.4 years (Q1-Q3: 5.1-14.7), during which 303 (5.5%) developed ESKD and 764 (14.0%) died of non-ESKD related causes. To account for the competing risk of death, rate models for the two events (ESKD and death) were estimated separately using Poisson regression analysis, censoring for the other event, and subsequently combined to give the cumulative incidence function for ESKD. External validation of the model is ongoing.

Results: The rate model for ESKD included age, male sex, diabetes duration, eGFR, albuminuria, urine albumin-to-creatinine ratio, systolic BP, HbA1c, haemoglobin, previous cardiovascular disease and retinopathy status. Model discrimination was excellent for up to 10-year risk of ESKD with C-statistics between 0.883 and 0.911 (Figure 1). Calibration was adequate for predicting up to 5-year risk of ESKD (P ≥ 0.166).

Conclusion: This tool for ESKD risk assessment could be an essential support for the decision on initiation of preventive treatment in persons with T1D. However, external validation is needed.

Disclosure

D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. G.S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S. A. Hulman: None. S. McGurnaghan: None. H.M. Colhoun: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Regeneron Pharmaceuticals, Sanofi-Aventis. Research Support; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk Inc., Novo Nordisk Inc., Pfizer Inc., Regeneron Pharmaceuticals, Sanofi-Aventis. Speaker’s Bureau; Self; Eli Lilly and Company, Regeneron Pharmaceuticals, Sanofi. Stock/Shareholder; Self; Bayer AG, Roche Pharma. Other Relationship; Self; Eli Lilly and Company, Sanofi. J. Henriksen: None. R.W. Thomsen: None. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; Amgen, AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S. P. Rossing: Advisory Panel; Self; Sanofi. Consultant; Self; Astellas Pharma Inc., AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Eli Lilly and Company. Stock/Shareholder; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.