title: Performance of the Framingham risk score in patients receiving hemodialysis.
abstract: OBJECTIVE
  The Framingham Risk Score (FRS), calculated by considering conventional risk factors of cardiovascular diseases, was developed to predict coronary heart disease in various populations. However, reverse epidemiology has been raised concerning these risk factors in predicting high cardiovascular mortality in hemodialysis patients. Our objectives are to determine whether FRS is associated with overall and cardiovascular mortality and the role of new risk markers when they were added to a FRS model in hemodialysis patients.
  
  
  METHODS
  This study enrolled 201 hemodialysis patients aged 20-80 years old. The FRS is used to identify individuals categorized as low (<6% 10-year risk), intermediate (6-20% risk) or high risk (>20% risk). Medical records were reviewed to collect clinical information. Data of ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were obtained by an ABI-form device.
  
  
  RESULTS
  The mean follow-up period was 4.4 ± 1.5 years. Intermediate risk predicted overall hazard ratio (HR) (2.157, P = 0.039) and cardiovascular mortality (HR= 5.023; P = 0.004) versus low risk, but 'high' risk did not. High risk (vs low risk) predicted cardiovascular events (HR = 2.458, P = 0.05). Besides, the addition of ABI < 0.9 (P = 0.021) and baPWV (P = 0.014) to a FRS model significantly improved the predictive value for overall mortality.
  
  
  CONCLUSIONS
  In hemodialysis patients, intermediate risk but not high risk categorization by FRS predicted overall and cardiovascular mortality, and high risk predicted cardiovascular events. ABI < 0.9 and baPWV provided additional predictive values for overall mortality. Future study is needed to develop hemodialysis-specific equations and assess whether risk refinement using ABI < 0.9 and baPWV leads to a meaningful change in clinical outcomes.
authors: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Jiun-Chi
authors: JC
authors: Huang
authors: Szu-Chia
authors: SC
authors: Chen
authors: Ho-Ming
authors: HM
authors: Su
authors: Jer-Ming
authors: JM
authors: Chang
authors: Shang-Jyh
authors: SJ
authors: Hwang
authors: Hung-Chun
authors: HC
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult