Applicability of the Framingham Risk Score in predicting mortality among kidney failure patients: an international analysis.

Background: The usefulness of the Framingham Risk Score (FRS) for estimation of mortality risk in kidney failure patients was explored in three cohorts of end-stage renal disease (ESRD) patients. Methods: Associations of the FRS with mortality risk were analysed among 392 Swedish non-dialysed (median age 56 years, males 62.8%, median FRS 19.5%) and 109 haemodialysed (median age 66 years, males 57.8%, median FRS 17.4%) ESRD patients and 1276 Chinese peritoneal dialysis (PD) patients (median age 50 years, males 55.6%, FRS 12.3%). We used Fine-Gray models to estimate relative risk associated with the FRS and its components, restricted mean survival time (RMST) to quantitate survival differences associated with the FRS and receiver operating characteristics curve analysis to estimate prognostic value of adding non-traditional risk factors to the FRS. Results: Despite different baseline characteristics, a 1 standard deviation increase in the FRS associated with similar increases (subhazard ratios 1.39-1.63) of both all-cause and cardiovascular mortality risk after adjusting for body mass index, serum albumin, haemoglobin and C-reactive protein (CRP). RMST and ∆RMST showed shorter survival time compared with all-cause and cardiovascular mortality in middle and high versus low FRS tertile. High versus low FRS tertiles showed 2- to 4-fold higher cumulative incident risk of all-cause and cardiovascular mortality. Adding non-traditional risk factors such as serum albumin and CRP to the FRS improved risk prediction marginally. Conclusions: A higher FRS associated with similar increases in mortality risk in three distinctly different cohorts of ESRD patients, whereas the addition of non-traditional risk factors had a negligible impact. The FRS is a valid tool for estimation of mortality risk in ESRD patients.