Kidney Week

Abstract: SA-PO283

A Global Validation of a Minimal-Resource Pre-Screening Model for Reduced Kidney Function in Patients With Type 2 Diabetes

Session Information

• Diabetic Kidney Disease: Clinical - II
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Sisk, Rose, Gendius Ltd, Macclesfield, United Kingdom

Rose Sisk,

• Sammut-Powell, Camilla, Gendius Ltd, Macclesfield, United Kingdom

Camilla Sammut-Powell,

• Budd, Jayne, Gendius Ltd, Macclesfield, United Kingdom

Jayne Budd,

• Cameron, Rory S B, Gendius Ltd, Macclesfield, United Kingdom

Rory S B Cameron,

• Edge, Mark P., Gendius Ltd, Macclesfield, United Kingdom

Mark P. Edge,

• Vazquez Mendez, Estefania, AstraZeneca, Mexico City, Mexico

Estefania Vazquez Mendez,

• Bedenkov, Aleksandr, AstraZeneca, Cambridge, United Kingdom

Aleksandr Bedenkov,

• Vasnawala, Hardik, AstraZeneca, Bangalore, India

Hardik Vasnawala,

• Goncalves, Susana, AstraZeneca, Buenos Aires, Argentina

Susana Goncalves,

Background

A minimal-resource (MR) pre-screening model has been developed in UK data for people with type 2 diabetes (T2DM) with no previous diagnosis of chronic kidney disease (CKD). It identifies those at higher risk of having reduced kidney function (eGFR < 60ml/min/1.73m²) using readily available non-clinical inputs. The model was developed to support prioritization of CKD screening resource, particularly where resources are limited. The model has previously been validated in global study data and whilst strong performance was observed, the data were limited in volume and collected prior to 2018.

The goal of this study is to test the performance of the model in up-to-date data, reflective of the application setting.

Methods

The model was applied to the observational iCaReMe registry data covering 21 countries in 7 regions globally from 2018. We evaluated the global and regional positive predictive values (PPV) at thresholds that ensured a sensitivity of at least 80%. We compared the PPV of the MR model against current practice (i.e. “screen all”, testing the entire T2DM population).

Results

5618 patients with a valid eGFR measurement were included. The MR model resulted in a PPV of 28.0% [95% CI: 26.5% - 29.6%] with a sensitivity of 82.4% [95% CI: 80.2% - 84.7%] - a relative improvement of 44.8% compared with the screen all approach (PPV 19.3% [95% CI: 18.3% - 20.4%]). Regional variation in performance was observed (Figure 1, PPV range of 23.8% - 34.9%), but the improvement remained significant in regions with sufficient sample size.

Conclusion

The MR model can be used globally to identify people with T2DM that are likely to have kidney function impairment, but should be adapted to regional populations. The model can be used to conduct targeted screening where resources are limited. Prioritized screening of high-risk individuals could help to address the backlog in routine care provision due to the COVID-19 pandemic.

A forest plot of the performance of the MR model. Positive predictive value of the model is compared against the "screen all" approach, overall and by region.