Keane et al reported a prognostic score for a patient with type 2 diabetes with nephropathy. The authors are from multiple institutions in the United States, Europe, and Australia.
RENAAL Study = Reduction of End Points in NIDDM with Angiotensin II Receptor Antagonist Losartan.
Patient selection: Type 2 diabetes with nephropathy
Outcome: end-stage renal diseaes (ESRD). A second score predicts ESRD and/or death.
Parameters:
(1) urine albumin to creatinine ratio (ACR) in mg per g
(2) serum albumin in g/dL
(3) serum creatinine in mg/dL
(4) hemoglobin in g/dL
Parameters
Points
ACR
1.96 * log(ACR)
serum albumin
-0.78 * (albumin)
serum creatinine
1.28 * (creatinine)
hemoglobin
-0.11 * (hemoglobin)
where:
• Whether LOG10 or LN not specified. Based on performance of the 2 options LN works better.
risk score =
= SUM(points for all of the parameters)
Interpretation:
• The higher the score the greater the risk of end-stage renal disease (ESRD) or death.
Total Score
Quartile
Hazard Ratio ESRD
< 3
1
1
3 to 4
2
3.3
4.01 to 5.1
3
13.6
> 5.1
4
49
A modification of the score to predict a composite outcome of ESRD death included hemoglobin A1c (page 764).
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