Assessment of cardiovascular risk using QRISK-3 in patients with chronic kidney disease: opportunities and limitations

Abstract

Background. Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease (CVD), yet traditional risk prediction models often underestimate the true risk in this population. QRISK-3, a contemporary CVD risk calculator developed in the UK, incorporates CKD as a specific variable. Objective(s). To evaluate the applicability, strengths, and limitations of the QRISK-3 tool in stratifying cardiovascular risk among patients with CKD in various stages of evolution and in hemodialysis patients. Materials and methods. The study included 200 patients with chronic kidney disease in KDIGO stage IV–V, from IMSP SCM "Sfânta Treime", in the period 2022–2023, assessed according to the QRISK-3 criteria. An analysis of the current evidence regarding the QRISK3 components, validation studies in CKD populations and comparison with alternative risk scores was performed. Results. Predictor variables were examined based on established risk factors and patients were classified as having an increased risk of cardiovascular disease if their 10-year risk was 10% or higher. Using the QRISK-3 tool, the number of patients included in the study with a 10-year risk score of 15% or higher was 84.5%, which denotes the major impact of cardiovascular complications in this vulnerable category of patients. QRISK-3 considerably improves risk estimation in CKD compared to previous models (e.g., Framingham, SCORE) but remains very limited in patients on dialysis or with advanced CKD (eGFR <30 mL/min/1.73 m²). Conclusion(s). Although the QRISK-3 score is a very useful tool for cardiovascular risk stratification in early-stage chronic kidney disease, further rigorous refinements and external validation are needed for practical application for patients with advanced CKD and dialysis patients.