Kidney Research and Clinical Practice 2019 Mar; 38(1): 49-59
Framingham risk score and risk of incident chronic kidney disease: A community-based prospective cohort study
Changhyun Lee1, Hae-Ryong Yun1, Young Su Joo1, Sangmi Lee1, Joohwan Kim1, Ki Heon Nam1,2, Jong Hyun Jhee3, Jung Tak Park1, Tae-Hyun Yoo1, Shin-Wook Kang1,4, Seung Hyeok Han1
1Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea, 2Division of Integrated Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, 3Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea, 4Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Korea
Correspondence to: Seung Hyeok Han, Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. E-mail:
Received: September 19, 2018; Revised: December 3, 2018; Accepted: December 12, 2018; Published online: March 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

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Background: Cardiovascular disease and chronic kidney disease share several common risk factors. The Framingham risk score is hypothesized to predict chronic kidney disease development. We determined if the Framingham risk scoring system can correctly predict incident chronic kidney disease in the general population.
Methods: This study included 9,080 subjects who participated in the Korean Genome and Epidemiology Study between 2001 and 2014 and had normal renal function. The subjects were classified into low- (< 10%), intermediate- (10-20%), and high- (> 20%) risk groups based on baseline Framingham risk scores. The primary endpoint was de novo chronic kidney disease development (estimated glomerular filtration rate [eGFR], < 60 mL/min/1.73 m2).
Results: During a mean follow-up duration of 8.9 ± 4.3 years, 312 (5.3%), 217 (10.8%), and 205 (16.9%) subjects developed chronic kidney disease in the low, intermediate, and high risk groups, respectively (P < 0.001). Multivariable analysis after adjustment for confounding factors showed the hazard ratios for the high- and intermediate risk groups were 2.674 (95% confidence interval [CI], 2.197-3.255) and 1.734 (95% CI, 1.447-2.078), respectively. This association was consistently observed irrespective of proteinuria, age, sex, obesity, or hypertension. The predictive power of this scoring system was lower than that of renal parameters, such as eGFR and proteinuria, but increased when both were included in the prediction model.
Conclusion: The Framingham risk score predicted incident chronic kidney disease and enhanced risk stratification in conjunction with traditional renal parameters in the general population with normal renal function.
Keywords: Chronic kidney disease, Framingham risk score, Korean Genome and Epidemiology Study, Proteinuria


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