Cardiovascular Risk Prediction with the Kidney Failure Risk Equation in the Chronic Renal Insufficiency Study

Area of Science:

• Nephrology
• Cardiology
• Epidemiology

Background:

• The Kidney Failure Risk Equation (KFRE) is widely used for predicting kidney failure in Chronic Kidney Disease (CKD) patients.
• CKD patients have a higher mortality rate from cardiovascular (CV) causes than renal causes.
• The predictive capability of KFRE for cardiovascular disease in CKD patients remains unclear.

Purpose of the Study:

• To investigate the association between the 8-variable, 5-year KFRE and the risk of cardiovascular disease and death in CKD patients.
• To evaluate the predictive performance of KFRE compared to the American Heart Association PREVENT equations.

Main Methods:

• Analysis of 3,203 CKD patients (eGFR 15-60 mL/min/1.73m2) from the Chronic Renal Insufficiency Cohort (CRIC) study.
• KFRE was modeled continuously and by quartiles to assess risk of composite CV disease (heart failure hospitalization, myocardial infarction, stroke) and death.
• Predictive discrimination was assessed using Harrell's C-statistic, comparing KFRE with AHA PREVENT equations in a subgroup without prior CV disease.

Main Results:

• Higher KFRE scores were significantly associated with increased risk of cardiovascular disease (HR 1.27 per log-unit) and death (HR 1.18 per log-unit).
• Quartile analysis showed a 3.34-fold higher risk of CV disease and a 2.38-fold higher risk of death for the highest KFRE quartile.
• In patients without prior CV disease, KFRE demonstrated moderate discrimination (C-statistic 0.642), while the UACR-enhanced AHA PREVENT equation showed superior performance (C-statistic 0.698).

Conclusions:

• Elevated KFRE scores correlate with increased risks of cardiovascular disease and mortality in CKD patients.
• KFRE offers moderate predictive ability for cardiovascular events, providing a dual-purpose tool for kidney and CV risk stratification.
• While PREVENT equations showed better discrimination, KFRE provides a simpler, single-tool approach for combined risk assessment.