Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients

Background The Framingham risk score ( FRS ) and cardiovascular risk calculator for renal transplant recipients ( CRCRTR ‐ MACE ) quantify cardiovascular risk in renal transplant recipients ( RTR ). In contrast to the FRS , the CRCRTR ‐ MACE includes serum creatinine as a variable in the risk prediction equation. Objective To determine the influence of impaired renal function on performances of the two equations. Methods A chart review of 270 RTR transplanted from 1979 to 2012. High risk was defined at scores ≥20%. Standard statistical analyses included multivariate analysis ( MVA ), stepwise analysis, and odds ratio to estimate contributions of risk factors. Results Mean transplant duration was 9.51 ± 6.65 yr. Mean eGFR was 59.19 ± 28.26 mL/min/1.73 m 2 . FRS and CRCRTR‐MACE scores of least 20% were present in 9.3% and 24.8%, respectively, while 7.2% and 11.2% of RTR with eGFR ≥60 mL/min/1.73 m 2 were high risk, respectively. Mean age, blood pressure, TC:HDL ratio, smoking, and diabetes were evenly distributed in patients with varying eGFR . FRS scores remained similar at wide eGFR range (≤30 mL/min/1.73 m 2 –≥90 mL/min/1.73 m 2 ), while CRCRTR‐MACE scores significantly increased as eGFR decreased. Conclusions CRCRTR ‐ MACE identified more patients at high cardiovascular risk, even in those with more favorable renal function, suggesting a fundamental difference between the two calculators beyond renal function.