Cardiovascular risk estimated in renal transplant recipients with the Framingham score

Cardiovascular disease is responsible for much of the mortality and morbidity observed in the renal transplant population. Some studies have applied the Framingham score mainly to the chronic kidney disease (CKD) on renal replacement therapy in an attempt to predict cardiovascular events, but the results underestimated the risk. It became evident at the participation of so-called nontraditional factors, such as anemia and inflammatory markers among others, were important predictors of risk in this population.

The aim of this study was to apply the Framingham score to a population of renal transplant subjects to assess its quality to predict cardiovascular events among a population without the theoretically nontraditional risk factors.

We retrospectively evaluated the medical records of patients transplanted from 2005 to 2010 for the score as determined by sex, age, blood pressure, low-density lipoprotein cholesterol, smoking history, and presence of diabetes mellitus. The final results expressed the risk for absolute development of cardiovascular diseases at the end of 10 years.

Among 126 patients including 44 women and, 82 men of mean age 45 ± 16 years were 64 living-related and 62 deceased-donor grafts. The etiology of CKD was hypertension (58%), diabetes (37%), and other causes (5%). Fifty-nine percent of patients had a low risk of developing coronary artery diseases at the end of 10 years, 30% medium risk, and only 11% high risk when measured by the Framingham score.

The assessment of cardiovascular risk using the Framingham risk score did not reflect the observations in the literature of both high mortality and high morbidity. Therefore, this was not a good method to assess the risk of cardiovascular disease, probably because it does not include cardiovascular risk factors in addition to traditional ones that are important in this population.