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Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study.

Publication ,  Journal Article
Bundy, JD; Rahman, M; Matsushita, K; Jaeger, BC; Cohen, JB; Chen, J; Deo, R; Dobre, MA; Feldman, HI; Flack, J; Kallem, RR; Lash, JP; Shafi, T ...
Published in: J Am Soc Nephrol
March 2022

BACKGROUND: Individuals with CKD may be at high risk for atherosclerotic cardiovascular disease (ASCVD). However, there are no ASCVD risk prediction models developed in CKD populations to inform clinical care and prevention. METHODS: We developed and validated 10-year ASCVD risk prediction models in patients with CKD that included participants without self-reported cardiovascular disease from the Chronic Renal Insufficiency Cohort (CRIC) study. ASCVD was defined as the first occurrence of adjudicated fatal and nonfatal stroke or myocardial infarction. Our models used clinically available variables and novel biomarkers. Model performance was evaluated based on discrimination, calibration, and net reclassification improvement. RESULTS: Of 2604 participants (mean age 55.8 years; 52.0% male) included in the analyses, 252 had incident ASCVD within 10 years of baseline. Compared with the American College of Cardiology/American Heart Association pooled cohort equations (area under the receiver operating characteristic curve [AUC]=0.730), a model with coefficients estimated within the CRIC sample had higher discrimination (P=0.03), achieving an AUC of 0.736 (95% confidence interval [CI], 0.649 to 0.826). The CRIC model developed using clinically available variables had an AUC of 0.760 (95% CI, 0.678 to 0.851). The CRIC biomarker-enriched model had an AUC of 0.771 (95% CI, 0.674 to 0.853), which was significantly higher than the clinical model (P=0.001). Both the clinical and biomarker-enriched models were well-calibrated and improved reclassification of nonevents compared with the pooled cohort equations (6.6%; 95% CI, 3.7% to 9.6% and 10.0%; 95% CI, 6.8% to 13.3%, respectively). CONCLUSIONS: The 10-year ASCVD risk prediction models developed in patients with CKD, including novel kidney and cardiac biomarkers, performed better than equations developed for the general population using only traditional risk factors.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

March 2022

Volume

33

Issue

3

Start / End Page

601 / 611

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Diseases
 

Citation

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Bundy, J. D., Rahman, M., Matsushita, K., Jaeger, B. C., Cohen, J. B., Chen, J., … the CRIC Study Investigators, . (2022). Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study. J Am Soc Nephrol, 33(3), 601–611. https://doi.org/10.1681/ASN.2021060747
Bundy, Joshua D., Mahboob Rahman, Kunihiro Matsushita, Byron C. Jaeger, Jordana B. Cohen, Jing Chen, Rajat Deo, et al. “Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study.J Am Soc Nephrol 33, no. 3 (March 2022): 601–11. https://doi.org/10.1681/ASN.2021060747.
Bundy JD, Rahman M, Matsushita K, Jaeger BC, Cohen JB, Chen J, et al. Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study. J Am Soc Nephrol. 2022 Mar;33(3):601–11.
Bundy, Joshua D., et al. “Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study.J Am Soc Nephrol, vol. 33, no. 3, Mar. 2022, pp. 601–11. Pubmed, doi:10.1681/ASN.2021060747.
Bundy JD, Rahman M, Matsushita K, Jaeger BC, Cohen JB, Chen J, Deo R, Dobre MA, Feldman HI, Flack J, Kallem RR, Lash JP, Seliger S, Shafi T, Weiner SJ, Wolf M, Yang W, Allen NB, Bansal N, He J, the CRIC Study Investigators. Risk Prediction Models for Atherosclerotic Cardiovascular Disease in Patients with Chronic Kidney Disease: The CRIC Study. J Am Soc Nephrol. 2022 Mar;33(3):601–611.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

March 2022

Volume

33

Issue

3

Start / End Page

601 / 611

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Diseases