Clinicians can enhance cardiovascular disease (CVD) risk prediction by incorporating Kidney Disease Improving Global Outcomes (KDIGO) risk categories, according to a recent study.
The categories are defined by estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR).
Investigators assessed CVD risks based on the traditional atherosclerotic cardiovascular disease (ASCVD) score alone and in combination with KDIGO risk categories using a cohort of 115,366 Chinese adults aged 40 years and older without CVD.
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Predicted risks for major CVD events increased significantly across the ASCVD risk strata and, separately, across the KDIGO risk categories. Adding eGFR and UACR to the ASCVD risk score, however, significantly improved the prediction of CVD development, risk stratification, and reclassification for major CVD events, investigators led by Weiqing Wang, MD, PhD, and Guang Ning, MD, PhD, of Shanghai Jiaotong University School of Medicine in Shanghai, China, reported in the Journal of the American Society of Nephrology.
In adults with a borderline or intermediate ASCVD score (7.5% to less than 10.0%), the risk for major CVD events was reclassified upward from 2.6- to 3.6- to 5.8-fold as KDIGO risk categories increased from low to intermediate to high or very high, respectively.
Cardiology professional organizations already recommend considering individual risk-enhancing clinical factors in addition to ASCVD score when making decisions about preventive treatment.
“For the primary prevention of cardiovascular disease, a comprehensive evaluation using both traditional and non-traditional risk factors is important,” Dr Wang stated in a news release from the American Society of Nephrology. “Evaluation using traditional risk factors such as glucose, blood pressure, and lipids could make a first stratification on your risk, and further evaluation using non-traditional risk factors related to kidney health could significantly refine the stratification and predict the risk more accurately.”
The ASCVD risk score evaluates 10-year risk of developing a first ASCVD event, defined as nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke. It is calculated using sex, antihypertensive treatment, age, total cholesterol, HDL cholesterol, systolic blood pressure, current smoking status, and diabetes. Scores range from less than 7.5% (low risk) to 7.5%-19.9% (intermediate risk) to more than 20.0% (high risk).
KDIGO risk categories are defined by eGFR (in mL/min/1.73 m2) and UACR (in mg/g). High risk includes eGFR 60 or more and UACR 300 or greater; eGFR 45-59 and UACR 30-299; or eGFR 30-44 and UACR less than 30. Very high risk includes eGFR less than 30; eGFR 30-44 and UACR 30 or greater; or eGFR 45-59 and UACR of 300 or greater.
Future studies should examine other populations using ASCVD score and KDIGO categories, according to the investigators.
References
Xu Y, Li M, Qin G, et al. Cardiovascular risk based on ASCVD and KDIGO categories in Chinese adults: a nationwide, population-based, prospective cohort study. J Am Soc Nephrol. doi:10.1681/ASN.2020060856
Assessing patients’ kidney health may help predict their risk of cardiovascular disease [news release]. American Society of Nephrology; March 4, 2021.
