Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients

Area of Science:

• Nephrology and Cardiovascular Medicine
• Risk Stratification in Renal Transplant Recipients

Background:

• Cardiovascular risk is quantified in renal transplant recipients (RTR) using the Framingham Risk Score (FRS) and the Cardiovascular Risk Calculator for Renal Transplant Recipients (CRCRTR-MACE).
• The CRCRTR-MACE uniquely incorporates serum creatinine into its risk prediction, unlike the FRS.

Purpose of the Study:

• To evaluate the impact of varying renal function on the performance of the FRS and CRCRTR-MACE in RTR.
• To compare the ability of both risk calculators to identify patients at high cardiovascular risk.

Main Methods:

• A retrospective chart review of 270 RTR transplanted between 1979 and 2012.
• High cardiovascular risk was defined as a score of 20% or greater.
• Statistical analyses included multivariate analysis, stepwise analysis, and odds ratio calculations to assess risk factor contributions.

Main Results:

• The CRCRTR-MACE identified a higher proportion of high-risk patients (24.8%) compared to the FRS (9.3%).
• Even among RTR with estimated glomerular filtration rates (eGFR) ≥60 mL/min/1.73 m(2), CRCRTR-MACE identified more high-risk individuals (11.2% vs. 7.2%).
• FRS scores showed minimal variation across a wide range of eGFR, whereas CRCRTR-MACE scores significantly increased as eGFR decreased.

Conclusions:

• The CRCRTR-MACE demonstrates a superior ability to identify RTR at high cardiovascular risk, including those with better renal function.
• This suggests a significant difference in risk assessment between the CRCRTR-MACE and FRS, extending beyond the consideration of renal function alone.