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The Framingham predictive instrument in chronic kidney disease
Daniel E Weiner1, Hocine Tighiouart, Essam F Elsayed
1Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. dweiner@tufts-nemc.org
Journal of the American College of Cardiology
|July 17, 2007
Summary
The Framingham equations poorly predict cardiac events in chronic kidney disease (CKD) patients. Refitted models improve accuracy, but CKD-specific equations are necessary for reliable risk assessment.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- The Framingham equations are established tools for predicting coronary heart disease (CHD) risk.
- Their accuracy and applicability in individuals with chronic kidney disease (CKD) remain unverified.
Purpose of the Study:
- To assess the utility of the Framingham equations for predicting coronary events in patients with CKD.
- To evaluate the discriminative and calibration performance of these equations in this population.
Main Methods:
- Pooled data from ARIC and CHS trials for individuals aged 45-74 years with CKD (eGFR 15-60 ml/min/1.73 m²).
- Gender-specific models were used to calculate 5- and 10-year risks of myocardial infarction and fatal coronary disease.
- Evaluated discrimination (C-statistics) and calibration of the Framingham equations.
Main Results:
- Framingham equations showed poor discrimination and calibration in individuals with CKD, generally underpredicting cardiac events.
- Refitting models with population-specific coefficients significantly improved discrimination.
- Recalibration enhanced prediction accuracy in women.
Conclusions:
- The Framingham equations have limited accuracy for cardiac event prediction in CKD patients.
- Model adjustments can improve discrimination and calibration, particularly in women.
- There is a critical need for developing CKD-specific cardiovascular risk prediction equations.
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