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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiovascular Risk Prediction with the Kidney Failure Risk Equation in the Chronic Renal Insufficiency Study
Simon Correa1, Valentina A Castro1, Iris E Beldhuis2,3
1Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
The Kidney Failure Risk Equation (KFRE) predicts higher cardiovascular disease and death risk in CKD patients. While less accurate than PREVENT, KFRE offers dual kidney and CV risk assessment using one tool.
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.
Background:
The Kidney Failure Risk Equation (KFRE) is an established tool to predict the risk of kidney failure among patients with CKD. Patients with CKD more often die from cardiovascular (CV) causes than renal causes, and more often experience a non-fatal CV event than progress to kidney failure. The CV predictive ability of the KFRE in CKD is unclear.
Methods:
We investigated the association of the 8-variable 5-year KFRE with CV disease (composite of heart failure hospitalization, myocardial infarction, or stroke) and death among 3,203 patients with eGFR 15-60 mL/min/1.73m2 in the Chronic Renal Insufficiency Cohort (CRIC). KFRE was modeled continuously and by quartiles. We evaluated KFRE's predictive performance in a subgroup of 2,124 patients without prior CV disease. Discrimination was assessed using Harrell's C-statistic, and compared to the American Heart Association PREVENT equations.
Results:
Mean eGFR was 38±11 mL/min/1.73 m2; median UACR was 71 [11, 523] mg/g; median KFRE score was 0.69 [0.19, 3.0] %. Over a median follow-up time of 8.6 years, 1128/3184 (35%) CV events occurred. KFRE score (per log-unit) was associated with a 27% higher risk of CV disease (HR 1.27; 95%CI 1.22-1.31), and an 18% higher risk of death (HR 1.18; 95%CI 1.15-1.22). In quartile analyses, KFRE was associated with a 3.34-fold higher risk of CV disease (HRQ4:Q1 3.34; 95%CI 2.77-4.03), and a 2.38-fold higher risk of death (HRQ4:Q1 2.38; 95%CI 2.04-2.78). Among those without prior CV disease (548 events over a median 10.6 years), KFRE showed modest discrimination (C-statistic 0.642), while the 10-year UACR-enhanced AHA PREVENT equation achieved 0.698 (p<0.001).
Conclusions:
A higher KFRE was associated with a higher risk of CV disease and death. Although lower than PREVENT, KFRE showed moderate discrimination for CV disease prediction, offering dual kidney and CV risk stratification with a single simple tool.
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