Association between kidney function and Framingham risk score in an admixed population of Brazil

http://dx.doi.org/10.1590/s2175-97902017000317185 Association between kidney function and Framingham risk score in an admixed population of Brazil Brunna Soares Rodrigues Costa1*, Erika Paula Silva Freitas2, Marina Sampaio Cruz1, Victor Hugo Rezende Duarte1, Ananília Medeiros Gomes da Silva1, Isabelle Cristina Clemente dos Santos1, Jéssica Cavalcante dos Santos1, Adriana Augusto Rezende1, Karine Cavalcanti Maurício Sena‑Evangelista2, Vivian Nogueira Silbiger1 1 Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil, 2 Department of Nutrition, Federal University of Rio Grande do Norte, Brazil Chronic kidney disease (CKD) increases cardiovascular disease (CVD) risk development. However, the mechanisms of reduced kidney function with CVD risk are unclear. This study aimed to investigate the association between kidney function and Framingham risk score (FRS) in participants with traditional cardiovascular risk factors and normal estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m² in an admixed population of Brazil. The participants were divided into three groups according to FRS: low risk group with 0% to <10%, moderate risk group with ≥10% to 20% and high risk group with >20%. The eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Data from participants were collected by questionnaire, and blood and urine samples were collected to analyze biochemical markers. A total of 214 subjects aged 53±10 years old was collected. There were 77 individuals in low risk group, 59 in moderate risk group and 78 in high-risk group. Mean eGFRCKD-EPI was 89.39±15.05 mL/min/1.73 m² and 90.74±16.17 mL/min/1.73 m2 when race adjustment. The results indicated that there is an increasing the cardiovascular risk with a decreased of eGFR, conforming to a significant inverse correlation observed between eGFR and FRS with Spearman correlation (R²=-0.256, p<0.001; R²=-0.224, p=0.001, when adjusted for race). There was a statistically significant difference in eGFRCKD-EPI (p<0.001) and eGFRCKD-EPI with race adjustment (p=0.002) among risk groups. The data suggests that the reduction eGFR is associated with elevated FRS among Brazilian adults without CKD. Furthermore, the results suggest that race adjustment it’s not necessary in Brazilian population. Keywords: Chronic kidney disease. Cardiovascular diseases/risk factors. Glomerular filtration rate. Framingham risk score (FRS). INTRODUCTION Chronic kidney disease (CKD), defined as renal damage or glomerular filtration rate <60 mL/min/1.73 m2 for at least 3 months (Andrew et al., 2005), is generally considered an independent risk factor for CVD (Sarnack et al., 2003; Olechnowicz-Tietz et al., 2013), increasing cardiovascular morbidity and mortality (Ito et al., 2015). However, kidney function mechanisms with cardiovascular risk in participants with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2 are unclear. *Correspondence: B. S. R. Costa. Universidade Federal do Rio Grande do Norte. Avenida General Gustavo Cordeiro de Farias, S/N, 59014-520, Natal, Rio Grande do Norte, Brasil,. E-mail: Braz. J. Pharm. Sci. 2017;53(3):e17185 Early diagnosis of CVD along with proper assessment of cardiovascular risk is crucial for further reduction of health care costs and mortality rates (Pereira, Barreto, Passos, 2009). Several cardiovascular risk prediction models have been developed to estimate risk, with the Framingham risk score (FRS) being among them. The FRS allows physicians to estimate the individual 10-year cardiovascular risk by using traditional cardiac risk factors including gender, age, systolic blood pressure, hypertension treatment, diabetes mellitus history, total cholesterol, highdensity lipoprotein cholesterol (HDL-cholesterol) and cigarette smoking (D’Agostino et al., 2008). In addition to traditional cardiovascular risk factors, other factors, as kidney function, are under investigation in association with CVD (Jin et al., 2014; Wang et al., 2014; Lu et al., 2016). Page 1 / 8 Article Brazilian Journal of Pharmaceutical Sciences B. S. R. Costa, E. P. S. Freitas, M. S. Cruz, V. H. R. Duarte, A. M. G. Silva, I. C. C. Santos, J. C. Santos, A. A. Rezende, K. C. M. Sena-Evangelista, V. N. Silbiger Microalbuminuria is an established biomarker that reflects glomerular damage and is closely associated with the risk of all causes and cardiovascular mortality and CVD events (Wang, Yan, Yu, 2013). However, this method requires urine samples and could show altered results due to collection errors. In clinical practice, measuring of plasma creatinine has been most-used the method to assess kidney function, however it alone is not a sensitive method to assess asymptomatic patients with chronic kidney disease (CKD) (Fontela et al., 2014). Instead, eGFR is the most feasible clinical measure of kidney function (KDIGO, 2013). Some studies have demonstrated that reduced eGFR is a predictor of major cardiovascular events (Jin et al., 2014; Wang et al., 2014; Ito et al., 2015; Lu et al., 2016). Jin and contributors (2014) suggested that kidney function was also independently associated with CVD in a Chinese population without CKD (defined as eGFR <60 mL/min/1.73 m²), however their population was approximately 99% Han Yellow race, and conflicting conclusions may be obtained in different populations comprising subjects from other races. Therefore, the aim of the study was to investigate the association between kidney function and cardiovascular risk in participants with normal eGFR >60 mL/min/1.73 m² in an admixed population of Brazil. MATERIAL AND METHODS Study population Originally, two-hundred and forty-eight participants were recruited for our study. However, two-hundred and fourteen male and female adults residents in the state of Rio Grande do Norte, Northeastern Brazil, were selected from the Hospital Universitário Onofre Lopes, at the Hemodynamics unit (n=138) who were undergoing cinecoronariography to investigate the presence and extent of coronary lesion and individuals from the Endocrinology unit (n=76) with metabolic syndrome criteria without endocrine disorders (except for diabetes mellitus). Exclusion criteria included diagnosis of chronic kidney disease (eGFR <60 mL/min/1.73 m²), elderly >70 years old, cardiomyopathy, heart valve disease, congenital diseases, pericarditis, coronary revascularization, liver failure, endocrine disorder (except for diabetes mellitus), chronic inflammatory diseases, malignant diseases, blood disorders, autoimmune diseases and family history of hypercholesterolemia. The study population was considered admixed due to the miscegenation of the Brazilian population, which is composed of several races. This study Page 2 / 8 was approved by the hospital’s Research Ethics Committee which complies with the Declaration of Helsinki under protocol number CAAE 0001.0.051.294-11 and a written informed consent was o (...truncated)