Comparison Of QRISK3 And Framingham Risk Scores For Estimating 10-Year CVD Risk In Patients With CKD

Abstract

Background: Chronic kidney disease (CKD) is strongly associated with increased cardiovascular morbidity and mortality, yet conventional cardiovascular risk prediction models may underestimate risk in this population because they do not account for CKD-specific determinants of vascular disease. Objective: To compare the cardiovascular risk stratification performance of QRISK3 and the Framingham Risk Score (FRS) and evaluate the clinical implications of risk reclassification among patients with CKD stages 3–5. Methods: A prospective cohort study was conducted at Pak Emirates Military Hospital, Rawalpindi, between January and December 2023. Two hundred fifty adults with CKD stages 3–5 underwent baseline cardiovascular risk estimation using both QRISK3 and the 2008 Framingham Risk Score. Participants were categorized into low (<10%), moderate (10–19%), and high (≥20%) risk groups. Risk reclassification was assessed using net reclassification improvement (NRI). Patients were followed for 12 months to document major adverse cardiovascular events (MACE). Discriminatory performance was evaluated using receiver operating characteristic curves. Results: QRISK3 classified significantly more patients as high risk compared with FRS (62.8% vs 32.4%, p < 0.001). Risk category changes occurred in 48.0% of participants, predominantly upward. MACE developed in 43.6% of patients during follow-up. Event rates were higher among individuals reclassified upward by QRISK3 (52.3% vs 31.5%, p = 0.002). The AUROC for predicting MACE was higher for QRISK3 than FRS (0.74 vs 0.66, p = 0.008), with an NRI of 0.18 (95% CI: 0.08–0.28). Conclusion: QRISK3 demonstrated superior cardiovascular risk stratification compared with the Framingham Risk Score in patients with CKD, identifying a greater proportion of individuals at high cardiovascular risk and showing improved predictive discrimination for adverse cardiovascular outcomes.