Incorporating kidney disease measures into cardiovascular risk prediction: Development and validation in 9 million adults from 72 datasets.
Link: https://doi.org/10.1016/j.eclinm.2020.100552
Authors: Matsushita, Kunihiro; Jassal, Simerjot K; Sang, Yingying; Ballew, Shoshana H; Grams, Morgan E; Surapaneni, Aditya; Arnlov, Johan; Bansal, Nisha; Bozic, Milica; Brenner, Hermann; Brunskill, Nigel J; Chang, Alex R; Chinnadurai, Rajkumar; Cirillo, Massimo; Correa, Adolfo; Ebert, Natalie; Eckardt, Kai-Uwe; Gansevoort, Ron T; Gutierrez, Orlando; Hadaegh, Farzad; He, Jiang; Hwang, Shih-Jen; Jafar, Tazeen H; Kayama, Takamasa; Kovesdy, Csaba P; Landman, Gijs W; Levey, Andrew S; Lloyd-Jones, Donald M; Major, Rupert W; Miura, Katsuyuki; Muntner, Paul; Nadkarni, Girish N; Naimark, David Mj; Nowak, Christoph; Ohkubo, Takayoshi; Pena, Michelle J; Polkinghorne, Kevan R; Sabanayagam, Charumathi; Sairenchi, Toshimi; Schneider, Markus P; Shalev, Varda; Shlipak, Michael; Solbu, Marit D; Stempniewicz, Nikita; Tollitt, James; Valdivielso, José M; van der Leeuw, Joep; Wang, Angela Yee-Moon; Wen, Chi-Pang; Woodward, Mark; Yamagishi, Kazumasa; Yatsuya, Hiroshi; Zhang, Luxia; Schaeffner, Elke; Coresh, Josef
Abstract: Chronic kidney disease (CKD) measures (estimated glomerular filtration rate [eGFR] and albuminuria) are frequently assessed in clinical practice and improve the prediction of incident cardiovascular disease (CVD), yet most major clinical guidelines do not have a standardized approach for incorporating these measures into CVD risk prediction. “CKD Patch” is a validated method to calibrate and improve the predicted risk from established equations according to CKD measures. Utilizing data from 4,143,535 adults from 35 datasets, we developed several “CKD Patches” incorporating eGFR and albuminuria, to enhance prediction of risk of atherosclerotic CVD (ASCVD) by the Pooled Cohort Equation (PCE) and CVD mortality by Systematic COronary Risk Evaluation (SCORE). The risk enhancement by CKD Patch was determined by the deviation between individual CKD measures and the values expected from their traditional CVD risk factors and the hazard ratios for eGFR and albuminuria. We then validated this approach among 4,932,824 adults from 37 independent datasets, comparing the original PCE and SCORE equations (recalibrated in each dataset) to those with addition of CKD Patch. The “CKD Patch” can be used to quantitatively enhance ASCVD and CVD mortality risk prediction equations recommended in major US and European guidelines according to CKD measures, when available. US National Kidney Foundation and the NIDDK.