Key result
Adding eGFR and uACR to SCORE2 improves the cardiovascular risk prediction c-statistic by ~0.02.
Why the study?
The 2021 ESC guideline qualitatively categorizes moderate and severe CKD as high or very-high CVD risk regardless of other factors and does not include eGFR and albuminuria in SCORE2 and SCORE2-OP.
Does adding CKD measures (eGFR and albuminuria) to SCORE2 and SCORE2-OP improve cardiovascular risk prediction compared to standard algorithms and qualitative guideline approaches?
Observational (n=9,049,907)
Yes
Does adding CKD measures (eGFR and albuminuria) to SCORE2 and SCORE2-OP improve cardiovascular risk prediction compared to standard algorithms and qualitative guideline approaches?
Incorporating quantitative CKD measures (eGFR and albuminuria) into SCORE2 and SCORE2-OP algorithms significantly improves cardiovascular risk prediction compared to standard algorithms and the qualitative approach in the 2021 ESC guidelines.
Answers are grounded in this paper and cite their sources.
Minimal c-statistic gain questions adding CKD markers to SCORE2; extends prior qualitative categorization without warranting practice change.
Background The 2021 ESC guideline on cardiovascular disease (CVD) prevention qualitatively categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, SCORE2 and SCORE2-OP, to predict CVD risk. Purpose To develop and validate an “Add-on” to incorporate CKD measures into these algorithms, using a validated approach. Methods In 3,054,840 participants from 34 datasets, we developed three Add-ons (eGFR only, eGFR + urinary albumin-to-creatinine ratio [ACR] [the primary Add-on], and eGFR + dipstick proteinuria) for SCORE2 and SCORE2-OP. We validated c-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,995,067 participants from 33 different datasets. Results In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved c-statistic by 0.006 (95% CI 0.005–0.008) and 0.018 (0.012–0.024), respectively, for SCORE2 and 0.012 (0.009–0.015) and 0.023 (0.013–0.032), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57,485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI (e.g., 0.100 [0.062–0.138] for SCORE2) compared to the qualitative approach in the ESC guideline. Conclusion Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): US National Kidney Foundation funding as well as US NIDDK
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Matsushita et al. (2022) conducted an observational in Cardiovascular disease risk (n=9,049,907). CKD Add-on (eGFR + ACR) vs. SCORE2 and SCORE2-OP alone or ESC guideline qualitative approach was evaluated on Improvement in c-statistic for cardiovascular disease risk prediction (c-statistic improvement 0.018, 95% CI 0.012-0.024). Incorporating eGFR and urinary albumin-to-creatinine ratio into the SCORE2 algorithm improved the c-statistic for cardiovascular risk prediction by 0.018.
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