Performance of clinical prediction models for chronic kidney disease among people with diabetes: external validation using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN)
Bibliographic record
Abstract
BACKGROUND: Several clinical prediction models that predict the risk of chronic kidney disease (CKD) in people with diabetes have been developed; however, these models lack external validation demonstrating accurate predictions in Canadian primary care. We externally validated existing clinical prediction models for CKD in Canadian primary care data, overall and across subgroups defined by sex/gender, age, comorbidities, and neighbourhood-level deprivation. METHODS: separated by ≥ 90 days and ≤ 1 year. For each model, we estimated the discrimination, precision, recall, and calibration within CPCSSN. RESULTS: Among 37,604 patients with diabetes, 14.6% met diagnostic criteria for CKD within 5 years. Overall performance of the 13 included CKD prediction models in CPCCSN was mixed: three models displayed moderate to strong discrimination (areas under the receiver-operating characteristic curves [AUROCs] > 0.70), whereas other AUROCs were as Low as 0.508. After model updating, calibrations were heterogeneous with most models displaying some miscalibration. Some subgroups displayed considerable differences in performance: discriminative performance (AUROC) declined with increasing age and number of comorbidities, whereas the precision and recall improved with increasing age and number of comorbidities. We observed no difference in performance according to sex/gender or deprivation quintile. CONCLUSIONS: Three models displayed moderate to strong performance predicting CKD among CPCSSN patients. Next, these models should be evaluated for their impact on practitioner and patient outcomes when implemented in clinical practice. If successful, these models hold promise in achieving widespread adoption to help identify those at highest risk of CKD and guide therapies that may prevent or delay CKD and related sequelae (e.g., end-stage renal disease) among people with diabetes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.064 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".