Arch Iran Med. 2019;22(2):91-98.
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Original Article

Loss of Inverse Association between Framingham Risk Score and Estimated Glomerular Filtration Rate in Moderate to Severe Diabetic Kidney Disease

Pegah Khaloo 1, Hamid Alemi 1, Mohammad Ali Mansournia 2, Soghra Rabizadeh 1, Salome Sadat Salehi 1, Michael J Blaha 3, Mohammad Hassan Mirbolouk 3, Hossein Mirmiranpour 1, Alireza Esteghamati 1, Manouchehr Nakhjavani 1 *

1 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3 Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, MD, USA


Background: We investigated the association of estimated glomerular filtration rate (eGFR) with Framingham risk score (FRS), and actual cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM). We also assessed improvement in FRS for prediction of CVD after inclusion of eGFR and albuminuria.

Methods: A total of 571 patients with T2DM and mean age 55 were divided into 2 groups based on the presence of CVD. Participants without CVD were then divided into three groups according to FRS. CVD is defined as an episode of CCU admission, Myocardial infarction, history of coronary artery bypass graft surgery or percutaneous intervention. FRS is calculated using the Wilson 1998 Circulation equation, which includes age, sex, high blood pressure, smoking, high-density lipoprotein (HDL), total cholesterol and diabetes as components to assess CVD risk in 10 years.

Results: An inverse adjusted association between eGFR and prevalent CVD was confirmed by multiple logistic regression analysis (OR = 0.84, 95% CI: 0.74, 0.94, P = 0.03). We observed every 10 mL/min/1.73 m2 decrease in eGFR is related to 3% increase in FRS in patients without chronic kidney disease (CKD) (coefficient = -0.03, P < 0.001). The association between FRS and GFR and also CVD and eGFR were not significant in patients with CKD (P = 0.12; P = 0.17, respectively). Predictive values for FRS components with and without considering eGFR and albuminuria were calculated (0.74 and 0.75, respectively).

Conclusion: Inclusion of eGFR and albuminuria in the FRS formula did not improve the predictive value of the model. We showed an inverse association between eGFR and FRS in early stages of diabetic kidney disease, which was lost in patients with CKD.

Keywords: Cardiovascular disease, Diabetic nephropathy, eGFR, Framingham risk score, Type 2 diabetes
Cite this article as: Khaloo P, Alemi H, Mansournia MA, Rabizadeh S, Salehi SS, Blaha MJ, et al. Loss of inverse association between Framingham risk score and estimated glomerular filtration rate in moderate to severe diabetic kidney disease. Arch Iran Med. 2019;22(2):91–98.
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Submitted: 24 May 2018
Accepted: 27 Oct 2018
First published online: 01 Feb 2019
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