Cardiovascular Risk Prediction Scores in CKD: What Are We Missing?

Soomro, Qandeel H; Charytan, David M.

doi:10.1681/asn.2022010039

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…For example, the updated KDIGO Glomerulonephritis Clinical Practice Guidelines suggested that lipid management follow the ASCVD risk stratification [ 35 ]. Yet, there is concern about residual CVD risk that is not completely addressed by established CVD risk factors and tools [ 5 , 36 ], especially in kidney disease [ 37 ] and in diabetes [ 38 ]. Thus, formal validation of the CVD risk tools and risk modification strategies (such as lipid and blood pressure targets suggested by the KDIGO Glomerulonephritis Clinical Practice Guidelines [ 35 ] but largely extrapolated from non-glomerulonephritis clinical trials [ 39 ]) is required for patients with kidney disease due to glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review

Roshan¹,

Choo²,

Lim³

2022

Glomerular Dis

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Background: Individuals with kidney diseases have increased risk of cardiovascular disease and death. Online cardiovascular risk assessment tools can educate patients on risks and modifiable factors. Since patients have variable health literacy, we evaluated the readability, understandability and actionability of publicly available online cardiovascular risk assessment tools. Methods: We systematically searched, reviewed, characterized and assessed English-language cardiovascular risk assessment tools online for readability (Flesch-Kincaid Grade Level (FKGL) score), understandability and actionability (Patient Education Materials Assessment Tool for printable materials (PEMAT-P)). Results: After screening 969 websites, 69 websites employing 76 risk tools were included. The most frequently used tools were the Framingham risk score (n= 13) and the Atherosclerotic Cardiovascular Disease score (n= 12), Most tools were intended for the general population and estimated the 10-year incident cardiovascular risk. Patient education was provided as targets for blood pressure (n= 17), lipids (n= 15), or glucose (n= 5); and advice regarding diet (n= 18), exercise (n= 19), and smoking cessation (n= 20). The median FKGL, PEMAT- understandability and actionability scores were 6.2 (4.7, 8.5), 84.6% (76.9%, 89.2%) and 60% (40%, 60%), respectively. Conclusion: The online cardiovascular risk tools were generally easy to read and understand, but only a third provided education on risk modification. Judicious selection of an online cardiovascular risk assessment tool may help patients in self-management.

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Section: Discussionmentioning

confidence: 99%

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review

Roshan¹,

Choo²,

Lim³

2022

Glomerular Dis

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A deep learning system for retinal vessel calibre improves cardiovascular risk prediction in Asians with chronic kidney disease

Lim,

Chong,

Tan

et al. 2023

Clinical Kidney Journal

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Background Cardiovascular disease (CVD) and mortality is elevated in chronic kidney disease (CKD). Retinal vessel calibre in retinal photographs is associated with cardiovascular risk and automated measurements may aid CVD risk prediction. Methods Retrospective cohort study of 860 Chinese, Malay and Indian participants aged 40–80 years with CKD (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2) who attended the baseline visit (2004–2011) of the Singapore Epidemiology of Eye Diseases Study. Retinal vessel calibre measurements were obtained by a deep learning system (DLS). Incident CVD (non-fatal acute myocardial infarction (MI) and stroke, and death due to MI, stroke and other CVD) in those who were free of CVD at baseline was ascertained until 31st December 2019. Risk factors (established, kidney and retinal features) were examined using Cox proportional hazards regression models. Model performance was assessed for discrimination, fit and net reclassification improvement (NRI). Results Incident CVD occurred in 289 (33.6%) over mean follow up of 9.3 (4.3) years. After adjusting for established cardiovascular risk factors, eGFR [adjusted HR 0.98 (95% CI: 0.97–0.99)] and retinal arteriolar narrowing [adjusted HR 1.40 (95% CI: 1.17–1.68)], but not venular dilation, were independent predictors for CVD in CKD. The addition of eGFR and retinal features to established cardiovascular risk factors improved model discrimination with significantly better-fit and better risk prediction according the low (<15%), intermediate (15–29.9%) and high (30% or more) risk categories (NRI 5.8%), and with higher risk thresholds (NRI 12.7%). Conclusions Retinal vessel calibre measurements by DLS were significantly associated with incident CVD independent of established CVD risk factors. Addition of kidney function and retinal vessel calibre parameters may improve CVD risk prediction among Asians with CKD.

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Undetected and undiagnosed comorbidity in patients with obesity undergoing bariatric surgery—Results from the Berlin Bariatric Cohort study

Pommer,

Krautschneider,

Kuhlmann

et al. 2024

Clinical Obesity

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SummaryThe quality of general obesity management before bariatric surgery (BS) is rarely investigated. Inadequate information regarding undetected and undiagnosed comorbidities (UUCs) in individuals with obesity may influence the penetration, risks, and outcomes of BS. We conducted a cohort study involving a pre‐specified medical check‐up in a cooperation between a BS department and an outpatient medical centre. A total of 1068 patients (74.4% women) were enrolled in the study. The mean age was 42.1 years (standard deviation [SD] 11.9) and the mean body mass index (BMI) was 46.1 (SD 6.91). The onset of obesity occurred in 11.4% of patients during childhood, 47.2% during schooltime/adolescence, 41.4% in adulthood. Gender differences were observed: men had higher BMI, systolic blood pressure, and impaired metabolic state (including diabetes, dyslipidemia, and liver disease with p‐values <.001 for all). Women had lower haemoglobin levels, impaired iron status, lower albumin levels (p < .001), and increased C‐reactive protein levels (p < .05). The prevalence of UUC conditions (percentage of cases) was as follows: arterial hypertension, 53%; decreased cystatin C clearance, 57%; dyslipidemia, 41%; fatty liver, 40%; iron deficiency, 37%; diabetes mellitus, 34%; vitamin D deficiency, 32%; chronic pain syndrome, 23%; liver fibrosis, 12%; obstructive sleep apnea, 10%; and vitamin deficiencies (vitamin B12, folic acid, vitamin K1) <10%. Undiagnosed hypertension was more prevalent in younger women, and nutritional deficits were associated with high BMI in both genders. Older age and high BMI were associated with undiagnosed diabetes and decreased glomerular filtration rate in both genders, and with liver fibrosis in men. UUC are highly prevalent in individuals undergoing BS. A refined assessment is recommended to improve health conditions and outcome in these candidates.

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Cardiovascular Risk Prediction Scores in CKD: What Are We Missing?

Cited by 3 publications

References 8 publications

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review

A deep learning system for retinal vessel calibre improves cardiovascular risk prediction in Asians with chronic kidney disease

Undetected and undiagnosed comorbidity in patients with obesity undergoing bariatric surgery—Results from the Berlin Bariatric Cohort study

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