| Title: |
Incorporating kidney disease measures into cardiovascular risk prediction: Development and validation in 9 million adults from 72 datasets |
| Authors: |
Matsushita, K; Jassal, SK; Sang, Y; Ballew, SH; Grams, ME; Surapaneni, A; Arnlov, J; Bansal, N; Bozic, M; Brenner, H; Brunskill, NJ; Chang, AR; Chinnadurai, R; Cirillo, M; Correa, A; Ebert, N; Eckardt, KU; Gansevoort, RT; Gutierrez, O; Hadaegh, F; He, J; Hwang, SJ; Jafar, TH; Kayama, T; Kovesdy, CP; Landman, GW; Levey, AS; Lloyd-Jones, DM; Major, RW; Miura, K; Muntner, P; Nadkarni, GN; Naimark, DM; Nowak, C; Ohkubo, T; Pena, MJ; Polkinghorne, KR; Sabanayagam, C; Sairenchi, T; Schneider, MP; Shalev, V; Shlipak, M; Solbu, MD; Stempniewicz, N; Tollitt, J; Valdivielso, JM; van der Leeuw, J; Wang, AYM; Wen, CP; Woodward, M; Yamagishi, K; Yatsuya, H; Zhang, L; Schaeffner, E; Coresh, J |
| Source: |
urn:ISSN:2589-5370 ; Eclinicalmedicine, 27, 100552 |
| Publisher Information: |
Elsevier |
| Publication Year: |
2020 |
| Collection: |
UNSW Sydney (The University of New South Wales): UNSWorks |
| Subject Terms: |
32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; 42 Health Sciences; Prevention; Heart Disease; Kidney Disease; Cardiovascular; Renal and urogenital; 3 Good Health and Well Being; Chronic kidney disease; cardiovascular disease; meta-analysis; risk prediction; anzsrc-for: 32 Biomedical and Clinical Sciences; anzsrc-for: 3202 Clinical Sciences; anzsrc-for: 42 Health Sciences; anzsrc-for: 4203 Health services and systems; anzsrc-for: 4206 Public health |
| Description: |
Background: 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. Methods: 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. Findings: We confirmed the prediction improvement with the CKD Patch for CVD mortality beyond SCORE and ASCVD beyond PCE in validation datasets (Δc-statistic 0.027 [95% CI 0.018–0.036] and 0.010 [0.007–0.013] and categorical net reclassification improvement 0.080 [0.032–0.127] and 0.056 [0.044–0.067], respectively). The median (IQI) of the ratio of predicted risk for CVD mortality with CKD Patch vs. the original prediction with SCORE was 2.64 (1.89–3.40) in very high-risk CKD (e.g., eGFR 30–44 ml/min/1.73m 2 with albuminuria ≥30 mg/g), 1.86 (1.48–2.44) in high-risk CKD (e.g., eGFR 45–59 ml/min/1.73m 2 with albuminuria 30–299 mg/g), and 1.37 (1.14–1.69) in moderate risk CKD (e.g., eGFR 60–89 ml/min/1.73m 2 with albuminuria 30–299 mg/g), indicating considerable risk underestimation in CKD with SCORE. The corresponding estimates for ASCVD ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
https://hdl.handle.net/1959.4/unsworks_84410; https://doi.org/10.1016/j.eclinm.2020.100552 |
| DOI: |
10.1016/j.eclinm.2020.100552 |
| Availability: |
https://hdl.handle.net/1959.4/unsworks_84410; https://unsworks.unsw.edu.au/bitstreams/bb24bbd9-f43a-4851-b136-faef66889169/download; https://doi.org/10.1016/j.eclinm.2020.100552 |
| Rights: |
open access ; https://purl.org/coar/access_right/c_abf2 ; CC BY-NC-ND ; https://creativecommons.org/licenses/by-nc-nd/4.0/ ; free_to_read |
| Accession Number: |
edsbas.67882A17 |
| Database: |
BASE |