Derivation and Validation of a Renal Risk Score for PeopleWith Type 2 Diabetes

OBJECTIVEdDiabetes has become the leading cause of end-stage renal disease (ESRD). Renal risk stratification could assist in earlier identification and targeted prevention. This study aimed to derive risk models to predict ESRD events in type 2 diabetes in primary care. RESEARCH DESIGN AND METHODSdThe nationwide derivation cohort included adults with type 2 diabetes from the New Zealand Diabetes Cohort Study initially assessed during 2000–2006 and followed until December 2010, excluding those with pre-existing ESRD. The outcome was fatal or nonfatal ESRD event (peritoneal dialysis or hemodialysis for ESRD, renal transplantation, or death from ESRD). Risk models were developed using Cox proportional hazards models, and their performance was assessed in a separate validation cohort. RESULTSdThe derivation cohort included 25,736 individuals followed for up to 11 years (180,497 person-years; 86 % followed for$5 years). At baseline, mean age was 62 years, median diabetes duration 5 years, and median HbA1c 7.2 % (55 mmol/mol); 37 % had albuminuria; and median estimated glomerular filtration rate (eGFR) was 77 mL/min/1.73 m2. There were 637 ESRD events (2.5%) during follow-up. Models that included sex, ethnicity, age, diabetes dura-tion, albuminuria, serum creatinine, systolic blood pressure, HbA1c, smoking status, and pre