Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy: the RENAAL study.

William F. Keane, Zhongxin Zhang, Paulette A. Lyle, Mark E. Cooper, Dick de Zeeuw, Jean Pierre Grunfeld, James P. Lash, Janet B. McGill, William E. Mitch, Giuseppe Remuzzi, Shahnaz Shahinfar, Steven M. Snapinn, Robert Toto, Barry M. Brenner

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Diabetic nephropathy is the most important cause of ESRD. The aim of this study was to develop a risk score from risk predictors for ESRD, with and without death, in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study and to compare ability of the ESRD risk score and its components to predict ESRD. The risk score was developed from coefficients of independent risk factors from multivariate analysis of baseline variables and equals (1.96 x log [urinary albumin:creatinine ratio]) - (0.78 serum albumin [g/dl]) + (1.28 x serum creatinine [mg/dl]) - (0.11 x hemoglobin [g/dl]). It was robust with respect to severity of nephropathy, gender, race, and treatment group. The risk score for ESRD or death was comparable. The four risk predictors for progression of kidney disease were independent of therapy. For combined treatment groups, the hazard ratio between the fourth and first quartiles of the ESRD risk score was 49.0, as compared with the corresponding hazard ratios for each component: 14.7 for urinary albumin:creatinine ratio, 9.2 for serum creatinine, 5.5 for hemoglobin, and 10.2 for serum albumin. The RENAAL risk scores for ESRD with or without death emphasize the importance of identification of level of albuminuria, serum albumin, serum creatinine, and hemoglobin to predict development of ESRD in patients with type 2 diabetes and nephropathy. Although albuminuria is a strong risk factor for ESRD, the contribution of serum albumin, serum creatinine, and hemoglobin level further enhances prediction of ESRD. Future trials with a similar patient population and outcomes measures should consider adjusting analyses for baseline risk factors.

Original languageEnglish (US)
Pages (from-to)761-767
Number of pages7
JournalClinical journal of the American Society of Nephrology : CJASN
Volume1
Issue number4
DOIs
StatePublished - Jul 2006

Fingerprint

Type 2 Diabetes Mellitus
Chronic Kidney Failure
Creatinine
Serum Albumin
Hemoglobins
Albuminuria
Serum
Albumins
Losartan
Kidney Diseases
Diabetic Nephropathies
Angiotensin II
Statistical Factor Analysis
Therapeutics
Multivariate Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy : the RENAAL study. / Keane, William F.; Zhang, Zhongxin; Lyle, Paulette A.; Cooper, Mark E.; de Zeeuw, Dick; Grunfeld, Jean Pierre; Lash, James P.; McGill, Janet B.; Mitch, William E.; Remuzzi, Giuseppe; Shahinfar, Shahnaz; Snapinn, Steven M.; Toto, Robert; Brenner, Barry M.

In: Clinical journal of the American Society of Nephrology : CJASN, Vol. 1, No. 4, 07.2006, p. 761-767.

Research output: Contribution to journalArticle

Keane, WF, Zhang, Z, Lyle, PA, Cooper, ME, de Zeeuw, D, Grunfeld, JP, Lash, JP, McGill, JB, Mitch, WE, Remuzzi, G, Shahinfar, S, Snapinn, SM, Toto, R & Brenner, BM 2006, 'Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy: the RENAAL study.', Clinical journal of the American Society of Nephrology : CJASN, vol. 1, no. 4, pp. 761-767. https://doi.org/10.2215/CJN.01381005
Keane, William F. ; Zhang, Zhongxin ; Lyle, Paulette A. ; Cooper, Mark E. ; de Zeeuw, Dick ; Grunfeld, Jean Pierre ; Lash, James P. ; McGill, Janet B. ; Mitch, William E. ; Remuzzi, Giuseppe ; Shahinfar, Shahnaz ; Snapinn, Steven M. ; Toto, Robert ; Brenner, Barry M. / Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy : the RENAAL study. In: Clinical journal of the American Society of Nephrology : CJASN. 2006 ; Vol. 1, No. 4. pp. 761-767.
@article{ed5897b9ba22489985dc19aefb9ed1a5,
title = "Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy: the RENAAL study.",
abstract = "Diabetic nephropathy is the most important cause of ESRD. The aim of this study was to develop a risk score from risk predictors for ESRD, with and without death, in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study and to compare ability of the ESRD risk score and its components to predict ESRD. The risk score was developed from coefficients of independent risk factors from multivariate analysis of baseline variables and equals (1.96 x log [urinary albumin:creatinine ratio]) - (0.78 serum albumin [g/dl]) + (1.28 x serum creatinine [mg/dl]) - (0.11 x hemoglobin [g/dl]). It was robust with respect to severity of nephropathy, gender, race, and treatment group. The risk score for ESRD or death was comparable. The four risk predictors for progression of kidney disease were independent of therapy. For combined treatment groups, the hazard ratio between the fourth and first quartiles of the ESRD risk score was 49.0, as compared with the corresponding hazard ratios for each component: 14.7 for urinary albumin:creatinine ratio, 9.2 for serum creatinine, 5.5 for hemoglobin, and 10.2 for serum albumin. The RENAAL risk scores for ESRD with or without death emphasize the importance of identification of level of albuminuria, serum albumin, serum creatinine, and hemoglobin to predict development of ESRD in patients with type 2 diabetes and nephropathy. Although albuminuria is a strong risk factor for ESRD, the contribution of serum albumin, serum creatinine, and hemoglobin level further enhances prediction of ESRD. Future trials with a similar patient population and outcomes measures should consider adjusting analyses for baseline risk factors.",
author = "Keane, {William F.} and Zhongxin Zhang and Lyle, {Paulette A.} and Cooper, {Mark E.} and {de Zeeuw}, Dick and Grunfeld, {Jean Pierre} and Lash, {James P.} and McGill, {Janet B.} and Mitch, {William E.} and Giuseppe Remuzzi and Shahnaz Shahinfar and Snapinn, {Steven M.} and Robert Toto and Brenner, {Barry M.}",
year = "2006",
month = "7",
doi = "10.2215/CJN.01381005",
language = "English (US)",
volume = "1",
pages = "761--767",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "4",

}

TY - JOUR

T1 - Risk scores for predicting outcomes in patients with type 2 diabetes and nephropathy

T2 - the RENAAL study.

AU - Keane, William F.

AU - Zhang, Zhongxin

AU - Lyle, Paulette A.

AU - Cooper, Mark E.

AU - de Zeeuw, Dick

AU - Grunfeld, Jean Pierre

AU - Lash, James P.

AU - McGill, Janet B.

AU - Mitch, William E.

AU - Remuzzi, Giuseppe

AU - Shahinfar, Shahnaz

AU - Snapinn, Steven M.

AU - Toto, Robert

AU - Brenner, Barry M.

PY - 2006/7

Y1 - 2006/7

N2 - Diabetic nephropathy is the most important cause of ESRD. The aim of this study was to develop a risk score from risk predictors for ESRD, with and without death, in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study and to compare ability of the ESRD risk score and its components to predict ESRD. The risk score was developed from coefficients of independent risk factors from multivariate analysis of baseline variables and equals (1.96 x log [urinary albumin:creatinine ratio]) - (0.78 serum albumin [g/dl]) + (1.28 x serum creatinine [mg/dl]) - (0.11 x hemoglobin [g/dl]). It was robust with respect to severity of nephropathy, gender, race, and treatment group. The risk score for ESRD or death was comparable. The four risk predictors for progression of kidney disease were independent of therapy. For combined treatment groups, the hazard ratio between the fourth and first quartiles of the ESRD risk score was 49.0, as compared with the corresponding hazard ratios for each component: 14.7 for urinary albumin:creatinine ratio, 9.2 for serum creatinine, 5.5 for hemoglobin, and 10.2 for serum albumin. The RENAAL risk scores for ESRD with or without death emphasize the importance of identification of level of albuminuria, serum albumin, serum creatinine, and hemoglobin to predict development of ESRD in patients with type 2 diabetes and nephropathy. Although albuminuria is a strong risk factor for ESRD, the contribution of serum albumin, serum creatinine, and hemoglobin level further enhances prediction of ESRD. Future trials with a similar patient population and outcomes measures should consider adjusting analyses for baseline risk factors.

AB - Diabetic nephropathy is the most important cause of ESRD. The aim of this study was to develop a risk score from risk predictors for ESRD, with and without death, in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study and to compare ability of the ESRD risk score and its components to predict ESRD. The risk score was developed from coefficients of independent risk factors from multivariate analysis of baseline variables and equals (1.96 x log [urinary albumin:creatinine ratio]) - (0.78 serum albumin [g/dl]) + (1.28 x serum creatinine [mg/dl]) - (0.11 x hemoglobin [g/dl]). It was robust with respect to severity of nephropathy, gender, race, and treatment group. The risk score for ESRD or death was comparable. The four risk predictors for progression of kidney disease were independent of therapy. For combined treatment groups, the hazard ratio between the fourth and first quartiles of the ESRD risk score was 49.0, as compared with the corresponding hazard ratios for each component: 14.7 for urinary albumin:creatinine ratio, 9.2 for serum creatinine, 5.5 for hemoglobin, and 10.2 for serum albumin. The RENAAL risk scores for ESRD with or without death emphasize the importance of identification of level of albuminuria, serum albumin, serum creatinine, and hemoglobin to predict development of ESRD in patients with type 2 diabetes and nephropathy. Although albuminuria is a strong risk factor for ESRD, the contribution of serum albumin, serum creatinine, and hemoglobin level further enhances prediction of ESRD. Future trials with a similar patient population and outcomes measures should consider adjusting analyses for baseline risk factors.

UR - http://www.scopus.com/inward/record.url?scp=33750601713&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750601713&partnerID=8YFLogxK

U2 - 10.2215/CJN.01381005

DO - 10.2215/CJN.01381005

M3 - Article

C2 - 17699284

AN - SCOPUS:33750601713

VL - 1

SP - 761

EP - 767

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 4

ER -