Abstract

Chronic kidney disease and cardiovascular disease are deeply interconnected conditions that together account for a substantial proportion of global morbidity and mortality. Patients with chronic kidney disease exhibit markedly elevated cardiovascular risk, driven by both traditional and non-traditional risk factors, including inflammation, endothelial dysfunction, and metabolic dysregulation. However, conventional cardiovascular risk prediction tools, such as the Pooled Cohort Equations and Systematic Coronary Risk Evaluation 2 (SCORE2), were developed in general populations and often underestimate risk in individuals with impaired kidney function. The recently developed Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations represent a paradigm shift by incorporating kidney function and metabolic variables, offering improved calibration and discrimination in contemporary populations. In parallel, the kidney disease: Improving Global Outcomes (KDIGO) classification provides a robust framework for assessing chronic kidney disease progression risk based on estimated glomerular filtration rate and albuminuria. While KDIGO effectively stratifies renal prognosis, it is not designed as a quantitative cardiovascular risk prediction model. This manuscript provides a comprehensive analysis of PREVENT, Pooled Cohort Equations, and SCORE2 models, with particular emphasis on their performance in chronic kidney disease populations, and contrasts them with KDIGO risk categories. We propose an integrated cardiorenal risk assessment approach combining these tools to improve clinical decisionmaking. Such integration is critical in the era of cardiorenal-metabolic therapeutics, including sodiumglucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which confer benefits across both cardiovascular and renal domains.

Keywords:Epidemiological models; Heart failure; KDIGO; PREVENT; SCORE2; Cardiovascular diseases; Chronic kidney disease

Abbreviations: CKD: Chronic Kidney Disease; eGFR: estimated Glomerular Filtration Rate; KDIGO: Kidney Disease: Improving Global Outcomes; PREVENT: Predicting Risk of Cardiovascular Disease EVENTs; SCORE2: Systematic Coronary Risk Evaluation2