The framingham predictive instrument in chronic kidney disease
The framingham predictive instrument in chronic kidney disease
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DOI：
10.1016/j.jacc.2007.03.037
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发表时间：
2007-07-17
影响因子：
24
通讯作者：
Sarnak, Mark J.
中科院分区：
文献类型：
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作者：
Weiner, Daniel E.;Tighiouart, Hocine;Sarnak, Mark J.
目的 我们试图确定弗雷明汉方程在慢性肾脏病（CKD）患者中的应用价值。
背景 弗雷明汉方程可预测冠心病的发生。这些方程在慢性肾脏病中的应用价值尚不明确。
方法 我们汇集了来自社区动脉粥样硬化风险研究（ARIC）和心血管健康研究（CHS）试验中年龄在45 - 74岁且患有慢性肾脏病（通过估算的肾小球滤过率为1.5 - 60 ml/min/1.73 m²定义）且无预先存在冠心病的个体。利用性别特异性模型，我们确定了发生心肌梗死和致命性冠心病的5年及10年风险，并评估了弗雷明汉方程预测冠心病事件的判别能力和校准能力。
结果 共有577名女性和357名男性患有慢性肾脏病。分别有35名男性（9.8%）和30名女性（5.2%）在5年内发生心脏事件，74名男性（20.7%）和56名女性（9.7%）在10年内发生心脏事件；男性和女性中分别有6.0%和1.9%被预测在5年内发生事件，13.9%和4.8%被预测在10年内发生事件。对于5年事件，评估判别能力的C统计量男性为0.62，女性为0.77，而10年C统计量男性为0.60，女性为0.73。校准情况也较差，弗雷明汉评分通常在5年和10年时低估了慢性肾脏病患者的事件发生情况。通过使用特定人群系数重新拟合模型，判别能力显著提高，而在女性中重新校准改善了预测情况。
结论 弗雷明汉工具在预测慢性肾脏病患者心脏事件方面总体准确性较差，尽管重新拟合的模型可显著提高判别能力。通过对较高事件发生率进行调整，女性的校准情况可适度改善。需要开发针对慢性肾脏病的特定方程。
Objectives We sought to determine the utility of the Framingham equations in individuals with chronic kidney disease (CKD).Background The Framingham equations predict incident coronary disease. The utility of these equations is unknown in CKD.Methods We pooled individuals without pre-existing coronary disease age 45 to 74 years from the ARIC (Atherosclerosis Risk In Communities) and CHS (Cardiovascular Health Study) trials with CKD, defined by an estimated glomerular filtration rate of 1.5 to 60 ml/min/1.73 m(2). Using gender-specific models, we determined 5- and 10-year risk of incident myocardial infarction and fatal coronary disease, and evaluated discriminative and calibration ability of the Framingham equations for predicting coronary events.Results There were 577 women and 357 men with CKD. Thirty-five men (9.8 %) and 30 women (5.2 %) and 74 men (20.7 %) and 56 women (9.7 %) had cardiac events within 5 and 10 years, respectively; 5-year events were predicted in 6.0 % and 1.9 % and 10-year events in 13.9 % and 4.8 % of men and women, respectively. For 5-year events, C-statistics assessing discrimination were 0.62 and 0.77, while 10-year C-statistics were 0.60 and 0.73 for men and women, respectively. Calibration was also poor, with Framingham scores generally underpredicting events in individuals with CKD at 5 and 10 years. Discrimination was significantly improved by refitting models with population-specific coefficients, while recalibration improved prediction in women.Conclusions The Framingham instrument demonstrates poor overall accuracy in predicting cardiac events in individuals with CKD, although refit models can substantially improve discrimination. Calibration in women can be moderately improved with adjustment for higher event rates. Development of CKD-specific equations is needed.