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Published on: June 16, 2014
Development and validation of cardiovascular risk scores for haemodialysis patients
Stefan D Anker1, Iain A Gillespie2, Kai-Uwe Eckardt3
1Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
Insights
New cardiovascular risk scores were developed for hemodialysis patients, outperforming traditional methods. These scores improve prediction of cardiovascular mortality and morbidity in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Hemodialysis patients lack a simple clinical tool for cardiovascular disease (CVD) risk prediction.
- The Framingham Heart Study Risk score (FRS) may be inadequate for this population.
- Novel risk scores for cardiovascular mortality (CVM) and cardiovascular morbidity & mortality (CVMM) were developed.
Purpose of the Study:
- To develop and validate new cardiovascular risk scores tailored for hemodialysis patients.
- To compare the predictive performance of new scores against the traditional FRS.
- To identify key predictors of cardiovascular events in this cohort.
Main Methods:
- A modified FRS approach was used to derive two-year risk scores.
- Incident European adult patients from a Fresenius Medical Care cohort (AROii) were used for development and internal validation.
- External validation was performed using the Dialysis Outcomes and Practice Patterns Study (DOPPS III) cohort.
Main Results:
- The new CVM score demonstrated better prediction (c-statistic 0.72-0.74) than the CVMM score (c-statistic 0.63-0.67).
- The traditional FRS was not predictive of CVM (c-statistic 0.54) or CVMM (c-statistic 0.56) in the AROii cohort.
- Key predictors included age, CVD history, diabetic nephropathy, low blood pressure, and inflammation.
Conclusions:
- Novel, easy-to-apply cardiovascular risk scores for hemodialysis patients have been developed.
- These scores show improved prediction performance compared to the FRS.
- The findings suggest potential novel cardiovascular risk factors in hemodialysis patients.
Background:
A simple clinical tool to predict cardiovascular disease risk does not exist for haemodialysis patients. The long-term coronary risk Framingham Heart Study Risk score (FRS), although used in this population, may be inadequate. Therefore, we developed separate risk-scores for cardiovascular mortality (CVM) and cardiovascular morbidity & mortality (CVMM) in a Fresenius Medical Care-based haemodialysis patient cohort (AROii).
Methods:
Applying a modified FRS approach, we derived and internally validated two-year risk-scores in incident European adult patients randomly assigned to a development (N=4831) or a validation (N=4796) dataset. External validation was conducted in the third Dialysis Outcomes and Practice Patterns Study (DOPPS III) cohort. Additional discrimination comparing to the FRS was performed.
Results:
The overall two-year CVM and CVMM event rates were 5.0 and 22.6 per 100 person-years respectively. Common risk predictors included increasing age, cardiovascular disease history, primary diabetic nephropathy, low blood pressure, and inflammation. The CVM score was more predictive in AROii (c-statistic 0.72) and in DOPPS III (c-statistic 0.73-0.74) than the CVMM score (c-statistic 0.66-0.67 & 0.63 respectively). The FRS was not predictive of either CVM (c-statistic 0.54) or CVMM (c-statistic 0.56) in AROii.
Conclusions:
We describe novel, easy-to-apply and interpret CV risk-scores for haemodialysis patients. Our improved cardiovascular prediction performance over traditional (FRS) scores reflected its tailored development and validation in haemodialysis populations, and the integration of non-classical cardiovascular risk factors. The lower expected versus observed CVM and CVMM risk suggests the existence of novel cardiovascular risk factors in this patient population not measured in this study.
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