Rodrigo Calabia, EmilioPich, SaraSubirana Cachinero, IsaacFernandez-Fresnedo, GemaBarreda Monteoliva, PalomaFerrer-Costa, Carlesde Francisco, Angel Luis M.Salas, EduardoElosua Llanos, RobertoArias, Manuel2018-05-082018-05-082017Rodrigo E, Pich S, Subirana I, Fernandez-Fresnedo G, Barreda P, Ferrer-Costa C. et al. A clinical-genetic approach to assessing cardiovascular risk in patients with CKD. Clin Kidney J. 2017 Oct;10(5):672-678. DOI: 10.1093/ckj/sfx0392048-8505http://hdl.handle.net/10230/34576BACKGROUND: Coronary heart disease (CHD) is the primary cause of death in individuals with chronic kidney disease (CKD), but current equations for assessing coronary risk have low accuracy in this group. We have reported that the addition of a genetic risk score (GRS) to the Framingham risk function improved its predictive capacity in the general population. The aims of this study were to evaluate the association between this GRS and coronary events in the CKD population and to determine whether the addition of the GRS to coronary risk prediction functions improves the estimation of coronary risk at the earliest possible stages of kidney disease. METHODS: A total of 632 CKD patients, aged 35-74 years, who had Stage 4-5 CKD, were on dialysis, had a functioning renal transplant or had returned to dialysis after transplant failure were included and followed up for a mean of 9.3 years. The transitions between disease states and the development of coronary events were registered. The increase in predictive ability that was obtained by including the GRS was measured as the improvement in the C-statistic and as the net reclassification index. RESULTS: The GRS was independently associated with the risk of CHD (hazards ratio 1.34; 95% confidence interval 1.04-1.71; P = 0.022), especially in Stages 4 and 5 CKD, and kidney transplant patients. A coronary risk prediction function that incorporated chronic kidney disease (CKD) disease state, age, sex and the GRS had significantly greater predictive capacity (AUC 70.1, P = 0.01) and showed good reclassification (net reclassification improvement 28.6). CONCLUSION: This new function, combining genetic and clinical data, identifies CKD patients with a high risk of coronary events more accurately, allowing us to prevent such events more effectively.application/pdfengCopyright © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comRonyons -- TrasplantacióCor -- Malaltiesinfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1093/ckj/sfx039Cardiovascular riskChronic kidney diseaseGenetic risk scoreKidney transplantPreventioninfo:eu-repo/semantics/openAccess