401. Derivation and validation of a machine learning risk score using biomarker and electronic patient data to predict progression of diabetic kidney disease.
- Author
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Chan L, Nadkarni GN, Fleming F, McCullough JR, Connolly P, Mosoyan G, El Salem F, Kattan MW, Vassalotti JA, Murphy B, Donovan MJ, Coca SG, and Damrauer SM
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Diabetic Nephropathies epidemiology, Diabetic Nephropathies pathology, Disease Progression, Female, Glomerular Filtration Rate, Humans, Kidney Function Tests statistics & numerical data, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Factors, United States epidemiology, Young Adult, Biomarkers analysis, Diabetic Nephropathies diagnosis, Electronic Health Records statistics & numerical data, Machine Learning
- Abstract
Aim: Predicting progression in diabetic kidney disease (DKD) is critical to improving outcomes. We sought to develop/validate a machine-learned, prognostic risk score (KidneyIntelX™) combining electronic health records (EHR) and biomarkers., Methods: This is an observational cohort study of patients with prevalent DKD/banked plasma from two EHR-linked biobanks. A random forest model was trained, and performance (AUC, positive and negative predictive values [PPV/NPV], and net reclassification index [NRI]) was compared with that of a clinical model and Kidney Disease: Improving Global Outcomes (KDIGO) categories for predicting a composite outcome of eGFR decline of ≥5 ml/min per year, ≥40% sustained decline, or kidney failure within 5 years., Results: In 1146 patients, the median age was 63 years, 51% were female, the baseline eGFR was 54 ml min
-1 [1.73 m]-2 , the urine albumin to creatinine ratio (uACR) was 6.9 mg/mmol, follow-up was 4.3 years and 21% had the composite endpoint. On cross-validation in derivation (n = 686), KidneyIntelX had an AUC of 0.77 (95% CI 0.74, 0.79). In validation (n = 460), the AUC was 0.77 (95% CI 0.76, 0.79). By comparison, the AUC for the clinical model was 0.62 (95% CI 0.61, 0.63) in derivation and 0.61 (95% CI 0.60, 0.63) in validation. Using derivation cut-offs, KidneyIntelX stratified 46%, 37% and 17% of the validation cohort into low-, intermediate- and high-risk groups for the composite kidney endpoint, respectively. The PPV for progressive decline in kidney function in the high-risk group was 61% for KidneyIntelX vs 40% for the highest risk strata by KDIGO categorisation (p < 0.001). Only 10% of those scored as low risk by KidneyIntelX experienced progression (i.e., NPV of 90%). The NRIevent for the high-risk group was 41% (p < 0.05)., Conclusions: KidneyIntelX improved prediction of kidney outcomes over KDIGO and clinical models in individuals with early stages of DKD.- Published
- 2021
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