Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP.
Link: https://doi.org/10.1093/eurjpc/zwac176
Authors: Matsushita, Kunihiro; Kaptoge, Stephen; Hageman, Steven H J; Sang, Yingying; Ballew, Shoshana H; Grams, Morgan E; Surapaneni, Aditya; Sun, Luanluan; Arnlov, Johan; 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; Jassal, Simerjot K; 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; Nowak, Christoph; Ohkubo, Takayoshi; Pena, Michelle J; Polkinghorne, Kevan R; Sairenchi, Toshimi; Schaeffner, Elke; Schneider, Markus P; Shalev, Varda; Shlipak, Michael G; 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; Dorresteijn, Jannick A N; Di Angelantonio, Emanuele; Visseren, Frank L J; Pennells, Lisa; Coresh, Josef
Abstract: The 2021 European Society of Cardiology (ESC) guideline on cardiovascular disease (CVD) prevention 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, systemic coronary risk estimation 2 (SCORE2) and systemic coronary risk estimation 2 in older persons (SCORE2-OP), to predict CVD risk. We developed and validated an ‘Add-on’ to incorporate CKD measures into these algorithms, using a validated approach. 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 5,997 719 participants from 34 different datasets. 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 0.004-0.008) and 0.016 (0.010-0.023), respectively, for SCORE2 and 0.012 (0.009-0.015) and 0.024 (0.014-0.035), 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. 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.