Derivation and validation of risk prediction models for albuminuria

in obese patients

Yue Zhang1, Wen-xing Gao2, Yi-ming Mu1

1
Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital,

100853
2
Department of General Surgery, the First Medical Center of Chinese PLA General Hospital,

100853

Objective: Over the past three decades, the prevalence of obesity has increased
significantly worldwide. Obesity and its complications such as kidney disease,
cardiovascular disease, and endocrine disease have brought heavy burden to public
health. The occurrence of albuminuria indicates the deterioration of renal function and
cardiac function in obese patients. Identification of related risk factors is expected to
help clinicians in early detection and management, and improve the prognosis of
patients. This study aims to establish and validate a risk prediction model for
albuminuria in obese patients.
Methods: The data of this study were obtained from the National Health and
Nutrition Examination Survey (NHANES). Albuminuria was defined as urinary
albumin-to-creatinine ratio ≥30 mg/g, and obesity was defined as body mass index
(BMI) ≥30kg/m2. The data were divided into derivation cohort and validation cohort
according to the ratio of 2∶1. In the derivation cohort, least absolute shrinkage and
selection operator (LASSO) regression analysis was used for 10-fold cross-validation
to screen out the prediction model with the best predictors. Further multivariate
logistic regression analysis was used to determine the independent risk factors
associated with albuminuria. Odds ratios (ORs) and 95% confidence intervals (CIs) of
the independent variables were calculated, and the model was visualized as a
nomogram to predict the probability of albuminuria. Bootstrap method was used to
internally validate the model, and external validation was performed in the validation
cohort to evaluate its performance.
Results: A total of 20475 obese patients were included, including 13656 in the
derivation cohort and 6819 in the validation cohort. Finally, a prediction model
including age, gender, fasting blood glucose, glycosylated hemoglobin, creatinine,
triglyceride, hypertension and body mass index was constructed. The area under the
receiver operating characteristic curve of derivation group and validation group was
0.735 and 0.729, respectively. The Hosmer-Lemeshow test results of the derivation
cohort and the validation cohort were 0.315 and 0.472, respectively. The calibration
curves showed high agreement between the nomogram predictions and actual
observations in both the derivation and validation cohorts.
Conclusions: This study identified risk factors associated with albuminuria in obese
patients, and further constructed a nomogram model with good predictive ability. On
the one hand, it provides a visual tool for clinicians to identify high-risk patients,
which is helpful for early intervention to delay disease progression or even reverse the
disease. On the other hand, obese patients can realize the importance of lowering
lipids, improve their living habits, and benefit from it.