title: Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients.
abstract: 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.
authors.affiliation: University of Saskatchewan, College of Medicine, Saskatoon, SK, Canada.
authors.forename: Mowad
authors.initials: M
authors.lastname: Benguzzi
authors.forename: Holly
authors.initials: H
authors.lastname: Mansell
authors.forename: Abubakar
authors.initials: A
authors.lastname: Hassan
authors.forename: Hamdi
authors.initials: H
authors.lastname: Elmoselhi
authors.forename: Rahul
authors.initials: R
authors.lastname: Mainra
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shoker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D055815:Young Adult
keywords: Framingham risk score; GFR; MACE; cardiovascular events; cardiovascular risk factors; kidney transplantation