Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP.
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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
Аннотация
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 5,997 719 participants from 34 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 0.004-0.008) 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.
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.