Adding estimated GFR and urinary albumin excretion to the Framingham equation does not substantially improve overall cardiovascular disease risk prediction in populations not enriched with CKD.
Does the addition of eGFR and albuminuria to the Framingham Risk Score improve cardiovascular disease risk prediction?
Adding kidney function markers to the Framingham Risk Score does not substantially improve CVD risk prediction in general populations, highlighting the need for CKD-specific risk equations.
Presence of chronic kidney disease (CKD) defined as decreased glomerular filtration rate (GFR) and/or increased urine albumin excretion is associated with heightened risk of cardiovascular disease (CVD) and all-cause as well as CVD mortality. Although CKD is strongly linked with CVD, it remains undetermined whether this strong association is simply due to shared CVD risk factors or unique traits consequential to CKD. The probability of future CVD events can be estimated with reasonable accuracy using the Framingham equation which was derived from the Framingham study, a community-based cohort of 5,209 white adults aged 30-62 years who were first examined in 1948. Efforts to capture excess CVD risk associated with CKD have been evaluated by adding estimated GFR, cystatin C, serum creatinine and measures of urinary albumin excretion to the Framingham equation which is based on traditional cardiovascular risk factors. Although decreased GFR and increased urine albumin excretion are consistently associated with cardiovascular outcomes, the addition of these factors to the Framingham equation has not been shown to substantially improve overall CVD risk prediction in populations not enriched with CKD. Moreover, the Framingham equation itself underpredicts cardiovascular events among adults with stage 3 and 4 CKD without clinical CVD. Given the poor performance of the Framingham equation in adults with CKD, future studies should explore risk equations which include traditional CVD risk factors and the unique comorbidities associated with CKD for prediction of cardiovascular events in adults with CKD.
Chang et al. (Thu,) conducted a review in Chronic Kidney Disease and Cardiovascular Disease. Addition of estimated GFR and urinary albumin excretion to the Framingham equation vs. Framingham equation alone was evaluated on Overall CVD risk prediction. Adding estimated GFR and urinary albumin excretion to the Framingham equation does not substantially improve overall cardiovascular disease risk prediction in populations not enriched with CKD.