Development and Validation of Prediction Models for Hypertensive Nephropathy, the PANDORA Study

IMPORTANCE: Hypertension is a leading cause of end-stage renal disease (ESRD), but currently, those at risk are poorly identified. OBJECTIVE: To develop and validate a prediction model for the development of hypertensive nephropathy (HN). DESIGN, SETTING, AND PARTICIPANTS: Individual data of cohorts of hypertensive patients from Kailuan, China served to derive and validate a multivariable prediction model of HN from 12, 656 individuals enrolled from January 2006 to August 2007, with a median follow-up of 6.5 years. The developed model was subsequently tested in both derivation and external validation cohorts. VARIABLES: Demographics, physical examination, laboratory, and comorbidity variables. MAIN OUTCOMES AND MEASURES: Hypertensive nephropathy was defined as hypertension with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2) and/or proteinuria. RESULTS: About 8.5% of patients in the derivation cohort developed HN after a median follow-up of 6.5 years that was similar in the validation cohort. Eight variables in the derivation cohort were found to contribute to the risk of HN: salt intake, diabetes mellitus, stroke, serum low-density lipoprotein, pulse pressure, age, hypertension duration, and serum uric acid. The discrimination by concordance statistics (C-statistics) was 0.785 (IQR, 0.770-0.800); the calibration slope was 1.129, the intercept was –0.117; and the overall accuracy by adjusted R(2) was 0.998 with similar results in the validation cohort. A simple points scale developed from these data (0, low to 40, high) detected a low morbidity of 7% in the low-risk group (0–10 points) compared with >40% in the high-risk group (>20 points). CONCLUSIONS AND RELEVANCE: A prediction model of HN over 8 years had high discrimination and calibration, but this model requires prospective evaluation in other cohorts, to confirm its potential to improve patient care.