Different Equations for Combined Chronic Kidney Disease and Cardiovascular Risk

Review Article

Abstract

Assessment of combined risk in chronic kidney disease and cardiovascular disease requires the use of multiple complementary tools, as no single model captures all relevant outcomes. Traditional cardiovascular risk scores, such as the Framingham Risk Score and the Atherosclerotic Cardiovascular Disease Risk Estimator, incorporate factors including age, sex, cholesterol levels, blood pressure, diabetes, and smoking. However, both have important limitations in chronic kidney disease, as kidney dysfunction is either not included or only indirectly considered, leading to underestimation of cardiovascular risk. The QRISK3 model represents a more suitable alternative for this population because it directly incorporates chronic kidney disease and proteinuria, along with additional variables such as body mass index and comorbidities, resulting in more accurate cardiovascular risk prediction. For renal outcomes, the Kidney Failure Risk Equation is the most widely validated tool, using demographic and laboratory parameters to estimate progression to end stage kidney disease, although it does not predict cardiovascular events. Combined models, such as those developed by the Chronic Kidney Disease Prognosis Consortium, integrate kidney function and albuminuria to predict both mortality and cardiovascular outcomes. Similarly, the Kidney Disease Improving Global Outcomes classification system provides a practical framework by combining estimated glomerular filtration rate and albuminuria to stratify risk of progression, cardiovascular events, and death. Biomarker-based approaches incorporating natriuretic peptides and troponin further enhance prediction, particularly for heart failure. Overall, optimal management requires an integrated approach combining cardiovascular and renal risk tools to improve prognostic accuracy and guide therapy.