Establishment and Validation of a Nomogram Model for Prediction of Diabetic Nephropathy in Type 2 Diabetic Patients with Proteinuria

Purpose: To establish and validate the nomogram model for predicting diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients with proteinuria.

Methods: A total of 102 patients with T2DM and proteinuria who underwent renal biopsy were included in this study. According to pathological classification of the kidney, the patients were divided into two groups, namely, a DN group (52 cases) and a non-diabetic renal disease (NDRD) group (50 cases). The clinical data were collected, and the factors associated with diabetic nephropathy (DN) were analyzed with multivariate logistic regression. A nomogram model for predicting DN risk was constructed by using R4.1 software. Receiver operator characteristic (ROC) curves were generated, and the K-fold cross-validation method was used for validation. A consistency test was performed by generating the correction curve.

Results: Systolic blood pressure (SBP), diabetic retinopathy (DR), hemoglobin (Hb), fasting plasma glucose (FPG) and triglyceride/cystatin C (TG/Cys-C) ratio were independent factors for DN in T2DM patients with proteinuria (P<0.05). The nomogram model had good prediction efficiency. If the total score of the nomogram exceeds 200, the probability of DN is as high as 95%. The area under the ROC curve was 0.9412 (95% confidence interval (CI) = 0.8981-0.9842). The 10-fold cross-validation showed that the prediction accuracy of the model was 0.8427. The Hosmer-Lemeshow (H-L) test showed that there was no significant difference between the predicted value and the actual observed value ( = 6.725, P = 0.567). The calibration curve showed that the fitting degree of the DN nomogram prediction model was good.

Conclusion: The nomogram model constructed in the present study improves the diagnostic efficiency of DN in T2DM patients with proteinuria, and it has a high clinical value.