背景:随着2型糖尿病(T2DM)慢性肾病(CKD)的新疗法的出现,应使用CKD进展模型评估其长期获益.现有模型提供了可以重用的不同建模方法,但是对于建模者来说,评估许多可用模型之间的共性和差异可能是具有挑战性的。此外,告知模型参数的数据和基本人口特征可能并不总是明显的。因此,本研究回顾并总结了T2DM中CKD的现有建模方法和数据源,作为未来模型开发的参考。
方法:本系统文献综述包括T2DM人群CKD的计算机模拟模型。搜索在PubMed(包括MEDLINE)中实现,Embase,还有Cochrane图书馆,到2021年10月。模型被分类为队列状态转换模型(cSTM)或个体患者模拟(IPS)模型。提取了模拟肾脏疾病状态的信息,CKD的风险方程,数据源,和主要数据源中派生队列的基线特征。
结果:审查确定了49个型号(21个IPS,28cSTM)。在状态转换模型中,五态结构是标准的,包括一种无肾脏疾病状态,三种肾脏疾病状态[通常包括白蛋白尿和终末期肾脏疾病(ESKD)],一个死亡状态。五个模型捕获了CKD回归,三个模型包括心血管疾病(CVD)。风险方程最常预测蛋白尿和ESKD发生率,而预测最多的CKD后遗症是死亡率和CVD。大多数数据来源是完善的登记册,队列研究,和临床试验通常在几十年前在高收入国家的主要白人人群中开始。最近的一些模型是根据特定国家的数据开发的,尤其是亚洲国家,或来自临床结果试验。
结论:在T2DM中建立CKD模型是一个活跃的研究领域,随着从非西方数据和单一数据源开发的IPS模型的趋势,主要是新型肾脏保护治疗的近期结果试验。
新疗法的临床效果及其成本通常是通过使用计算机模拟模型在比临床试验更长时间内评估的。随着治疗慢性肾脏病的新疗法的出现,包括2型糖尿病患者,慢性肾脏病模型可用于为有关这些新治疗方案的临床和经济决策提供信息.在本研究中,我们确定了49个已发表的用于2型糖尿病人群的慢性肾脏疾病模拟模型,并审查了他们的结构和他们使用的数据源。这些模型主要集中在与蛋白尿(在尿液中发现蛋白质白蛋白的状况)和终末期肾脏疾病相关的疾病状态和结果。具有五种疾病状态的模型结构,包括无肾脏疾病状态,三种肾脏疾病状态,和死亡,是最常见的。相对较少的模型使用肾小球滤过率(肾功能的常见量度)或捕获慢性肾脏疾病改善的可能性。许多模型的重要数据来源是患者登记,队列研究,和临床试验,大多数是几十年前在白人参与者比例很高的高收入国家进行的。在过去5年中开发的几个模型,尤其是亚洲国家,相反,主要或完全依赖特定国家的数据。并行,最近从新的治疗方法的大型结果试验中开发了几个个体患者模拟,包括涵盖特定地理环境或种族的试验亚组,在试验发表后不久。
BACKGROUND: As novel therapies for chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) become available, their long-term benefits should be evaluated using CKD progression models. Existing models offer different modeling approaches that could be reused, but it may be challenging for modelers to assess commonalities and differences between the many available models. Additionally, the data and underlying population characteristics informing model parameters may not always be evident. Therefore, this study reviewed and summarized existing modeling approaches and data sources for CKD in T2DM, as a reference for future model development.
METHODS: This systematic literature
review included computer simulation models of CKD in T2DM populations. Searches were implemented in PubMed (including MEDLINE), Embase, and the Cochrane Library, up to October 2021. Models were classified as cohort state-transition models (cSTM) or individual patient simulation (IPS) models. Information was extracted on modeled kidney disease states, risk equations for CKD, data sources, and baseline characteristics of derivation cohorts in primary data sources.
RESULTS: The
review identified 49 models (21 IPS, 28 cSTM). A five-state structure was standard among state-transition models, comprising one kidney disease-free state, three kidney disease states [frequently including albuminuria and end-stage kidney disease (ESKD)], and one death state. Five models captured CKD regression and three included cardiovascular disease (CVD). Risk equations most commonly predicted albuminuria and ESKD incidence, while the most predicted CKD sequelae were mortality and CVD. Most data sources were well-established registries, cohort studies, and clinical trials often initiated decades ago in predominantly White populations in high-income countries. Some recent models were developed from country-specific data, particularly for Asian countries, or from clinical outcomes trials.
CONCLUSIONS: Modeling CKD in T2DM is an active research area, with a trend towards IPS models developed from non-Western data and single data sources, primarily recent outcomes trials of novel renoprotective treatments.
The clinical effects of new treatments and their costs are often evaluated over a longer time frame than is possible in clinical trials by using computer simulation models. As new treatments are becoming available to treat chronic kidney disease, including in patients with type 2 diabetes, chronic kidney disease models may be used to inform clinical and economic decisions regarding these new treatment options. In the present study, we identified 49 published simulation models of chronic kidney disease used in populations with type 2 diabetes, and reviewed their structures and the data sources they used. The models focused mostly on disease states and outcomes associated with albuminuria (a condition in which the protein albumin is found in the urine) and end-stage kidney disease. Model structures with five disease states, including a kidney disease-free state, three kidney disease states, and death, were the most common. Relatively few models used glomerular filtration rates (a common measure of kidney function) or captured the possibility of an improvement in chronic kidney disease. Important data sources for many models were patient registries, cohort studies, and clinical trials, most conducted several decades ago in high-income countries with a high proportion of White participants. Several models developed in the past 5 years, particularly for Asian countries, instead relied largely or exclusively on country-specific data. In parallel, several individual patient simulations were recently developed from large outcomes trials for new treatments, including from trial subgroups covering specific geographical settings or ethnicities, shortly after trial publication.