A Simplified Prediction Model for End-stage Kidney Disease in Patients With Diabetes

Abstract This study aimed to develop a simplified model for predicting end-stage kidney disease (ESKD) in patients with diabetes. The cohort included 2,549 individuals who were followed up at Kyushu University Hospital (Japan) between January 1, 2008 and December 31, 2018. The outcome was a composite of ESKD, defined as an eGFR < 15 mL min− 1 [1.73 m]−2, dialysis, or renal transplantation. The mean follow-up was 5.6 \(\pm\) 3.7 years, and ESKD occurred in 176 (6.2 ) individuals. Both a machine learning random forest model and a Cox proportional hazard model selected eGFR, proteinuria, hemoglobin A1c, serum albumin levels, and serum bilirubin levels in a descending order as the most important predictors among 20 baseline variables. A model using eGFR, proteinuria and hemoglobin A1c showed a relatively good performance in discrimination (C-statistic: 0.842) and calibration (Nam and D’Agostino \(\chi\)2 statistic: 22.4). Adding serum albumin and bilirubin levels to the model further improved it, and a model using 5 variables showed the best performance in the predictive ability (C-statistic: 0.895, \(\chi\)2 statistic: 7.7). The accuracy of this model was validated in an external cohort (n = 5,153). This novel simplified prediction model may be clinically useful for predicting ESKD in patients with diabetes.