Table 2.
CV risk stratification of CKD patients according to 2019 ESC lipid guidelines and 2021 ESC CVD prevention guidelines
| Total (n = 56 435) | Women (26 955) | Men (29 480) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 2019 ESC | 2021 ESC | P | 2019 ESC | 2021 ESC | P | 2019 ESC | 2021 ESC | P | |
| Very high risk, n (%) | 19 572 (34.7) | 20 702 (36.7) | <0.001 | 7 682 (28.5) | 8 289 (30.8) | <0.001 | 11 890 (40.3) | 12 413 (42.1) | <0.001 |
| (2019/2021) Documented ASCVD | 16 425 (29.1) | 16 425 (29.1) | 6095 (22.6) | 6095 (22.6) | 10 330 (35.0) | 10 330 (35.0) | |||
| (2019) T2DM with TOD or ≥3 risk factors, or T1DM of long duration (>20 years) | 11 380 (20.2) | – | 4620 (17.1) | – | 6760 (22.9) | – | |||
| (2019) Severe CKD (eGFR <30) | 4008 (7.1) | – | 2295 (8.5) | – | 1713 (5.8) | – | |||
| (2019) SCORE ≥10% | NA | – | NA | – | NA | – | |||
| (2019) FH with ASCVD or another major risk factor | 581 (1.0) | – | 292 (1.1) | – | 289 (1.0) | – | |||
| (2021) T2DM with established ASCVD and/or severe TODa | – | 10 952 (19.4) | – | 4448 (16.5) | – | 6504 (22.1) | |||
| (2021) CKD without DM or ASCVD: eGFR <30 or eGFR 30–44 and UACR >30 | – | 3268 (5.8) | – | 1876 (7.0) | – | 1392 (4.7) | |||
| (2021) SCORE2: <50 years ≥7.5%; 50–69 years ≥10%; SCORE2-OP: ≥70 years ≥15%b | – | NA | – | NA | – | NA | |||
| High risk, n (%) | 25 565 (45.3) | 30 244 (53.6) | <0.001 | 13 316 (49.4) | 16 191 (60.1) | <0.001 | 12 249 (41.6) | 14 053 (47.7) | <0.001 |
| (2019) Markedly elevated single risk factors | 6147 (10.9) | – | 3254 (12.1) | – | 2893 (9.8) | – | |||
| (2019) FH without other major risk factors | 12 728 (22.6) | – | 6384 (23.7) | – | 6344 (21.5) | – | |||
| (2019) DM without TOD, with DM duration ≥10 years or another additional risk factor | 17 042 (30.2) | – | 8436 (31.3) | – | 8606 (29.2) | – | |||
| (2019) Moderate CKD ESC 2019 (eGFR 30–59) | 12 364 (21.9) | – | 6852 (25.4) | – | 5512 (18.7) | – | |||
| (2019) SCORE ≥5% and <10% | NA | – | NA | – | NA | – | |||
| (2021) T2DM without ASCVD and/or severe TOD and not fulfilling the moderate risk criteria | – | 19 866 (35.2) | – | 10 557 (39.2) | – | 9309 (31.6) | |||
| (2021) CKD without diabetes or ASCVD: eGFR 30–44 and UACR <30 or eGFR 45–59 and UACR 30–300 or eGFR ≥60 and UACR >300 | – | 10 378 (18.4) | – | 5634 (20.9) | – | 4744 (16.1) | |||
| (2021) FH | – | NAd | – | NAd | – | NAd | |||
| (2021) SCORE2: <50 years 2.5–<7.5%; 50–69 years 5–<10%; SCORE2-OP: ≥70 years 7.5–<15%b | – | NA | – | NA | – | NA | |||
| Moderate risk, n (%) | 9183 (16.3) | 4076 (7.2) | <0.001 | 4829 (17.9) | 1901 (7.1) | <0.001 | 4354 (14.8) | 2175 (7.4) | <0.001 |
| (2019) SCORE ≥1% and <5% | 6069 (10.8) | – | 3223 (12.0) | – | 2846 (9.7) | – | |||
| (2019) Young patients with DM duration <10 years, without other risk factors. | 5215 (9.2) | – | 2532 (9.4) | – | 2683 (9.1) | – | |||
| (2019) eGFR ≥60 with UACR 30–300 | NA | – | NA | – | NA | – | |||
| (2021) Well controlled short-standing DM (e.g. <10 years), no evidence of TOD and no additional ASCVD risk factors | – | 0 | – | 0 | – | 0 | |||
| (2021) eGFR >60 and UACR 30–300c | – | 4076 (7.2) | – | 1901 (7.1) | – | 2175 (7.4) | |||
| (2021) SCORE2: <50 years <2.5%; 50–69 years < 5%; SCORE2-OP: ≥70 years <7.5%b | – | NA | – | NA | – | NA | |||
| Low risk, n (%) | 2115 (3.7) | 0 | <0.001 | 1128 (4.2) | 0 | <0.001 | 987 (3.3) | 0 | <0.001 |
| (2019) SCORE <1% | 2115 (3.7) | – | 1128 (4.2) | – | 987 (3.3) | – | |||
| (2019) eGFR >60 with UACR <30 | NA | – | NA | – | NA | – | |||
| (2021) SCORE2: <50 years <2.5%; 50–69 years <5%; SCORE2-OP: ≥70 years <7.5%b | – | NA | – | NA | – | NA | |||
| CKD patients not fitting categories abovee | 0 | 1 413 (2.5) | <0.001 | 0 | 574 (2.1) | <0.001 | 0 | 839 (2.8) | <0.001 |
ASCVD: atherosclerotic cardiovascular disease; CKD: chronic kidney disease; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; ESC: European Society of Cardiology; FH: familial hypercholesterolemia; SCORE: Systematic COronary Risk Estimation; SCORE2: Systemic COronary Risk Estimation 2; SCORE2-OP: Systematic COronary Risk Estimation 2-older persons; T1DM: type 1 DM; T2DM: type 2 DM; TOD: target organ damage; UACR: urine albumin-to-creatinine ratio.
TOD: eGFR < 45 mL/min/1.73 m2 irrespective of albuminuria, eGFR 45–59 mL/min/1.73 m2 and microalbuminuria (UACR 30–300 mg/g), proteinuria (UACR >300 mg/g) or presence of microvascular disease in at least three different sites (e.g. microalbuminuria plus retinopathy plus neuropathy).
bSCORE2 and SCORE2-OP were not calculated, as all patients had CKD.
cThis criterion has not been included in 2021 ESC guidelines, but was added to classify all CKD patients.
dAlready included in the other subgroups.
eThese patients had the diagnosis of CKD, but data about eGFR were not available. UACR: mg/g; eGFR: mL/min/1.73 m2.