New Risk Score For Heart Disease in CKD Patients
The combination of the Framingham risk function and a genetic risk score (GRS) has improved risk prediction for coronary heart disease among patients with chronic kidney disease (CKD), according to a recent study.
It is well known that coronary heart disease is the primary cause of death among patients with CKD. However, current equations that aim to predict the risk of coronary heart disease in these patients have demonstrated poor accuracy.
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For their study, the researchers evaluated 632 patients age 35 to 74 years with Stage 4 or 5 CKD. All patients included in the study were on dialysis, had a functioning renal transplant, or had returned to dialysis following transplant failure. Follow-up lasted a mean 9.3 years.
Data on transitions between disease states and the occurrence of coronary events were recorded. Any increase in the predictive ability of the Framingham risk function in combination with the GRS was measured as the improvement in the C-statistic and as the net reclassification index.
Results indicated that the GRS had been independently associated with the risk of coronary heart disease, especially among patients with Stage 4 or 5 CKD, and among those who had undergone kidney transplantation.
Ultimately, the researchers found that predictive capacity (area under the curve: 70.1) and reclassification (net reclassification improvement: 28.6) had significantly improved with a coronary risk prediction equation that had incorporated the GRS, along with CKD disease state, age, and sex.
“This new function, combining genetic and clinical data, identifies CKD patients with a high risk of coronary events more accurately, allowing us to prevent such events more effectively,” the researchers concluded.
—Christina Vogt
Reference:
Rodrigo E, Pich S, Subirana I, et al. A clinical-genetic approach to assessing cardiovascular risk in patients with CKD. Clin Kidney J. 2017;10(5):672-678. https://doi.org/10.1093/ckj/sfx039.