Kidney Week

Abstract: TH-PO1129

Recategorization and Differential Mortality Comparing the PREVENT Equations with the Pooled Cohort Equations Among People with CKD

Session Information

• CKD: Therapies, Innovations, and Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States

Lucile Parker Gregg, MD, MS, FASN

• Chang, Ryan, Baylor College of Medicine, Houston, Texas, United States

Ryan Chang

• Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States

Peter Richardson, PhD

• Matheny, Michael Edwin, Vanderbilt University, Nashville, Tennessee, United States

Michael Edwin Matheny, MD, MS, MPH

• Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States

Carl P. Walther, MD, PhD, FASN

• Rangaswami, Janani, The George Washington University, Washington, District of Columbia, United States

Janani Rangaswami, MD

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan, MD, MS, MPH, FASN

Background

The Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations include the estimated glomerular filtration rate (eGFR) and other parameters to improve cardiovascular disease risk prediction compared to the Pooled Cohort Equations (PCEs). We compared atherosclerotic cardiovascular disease (ASCVD) risk using the PREVENT equations and PCEs in individuals with chronic kidney disease (CKD) and assessed the associations of predicted risk with death.

Methods

Using national data from the Veterans Affairs from 2005-2022, we identified adults with incident CKD stages 3-4, defined as two eGFR values <60 mL/min/1.73 m² ≥90 days apart. We estimated 10-year ASCVD risk at the time of incident CKD using PREVENT ASCVD and PCEs, with risk categorized as low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), and high (≥20%). We assessed how many individuals were recategorized to a different risk category using the PREVENT equations compared to the PCEs. Kaplan-Meier curves assessed the relationship of risk categories with all-cause death over 10 years of follow up.

Results

There were 1,147,416 individuals with both a calculable PCE and PREVENT risk score included in the cohort. Of these, 499,937 (43.6%) were categorized in the same risk category by the two equations, 638,975 (55.7%) were recategorized to a lower risk category by PREVENT than by PCEs, and 8,504 (0.7%) were recategorized to a higher risk category by PREVENT than by PCEs (Figure 1A). The PREVENT high and intermediate risk categories had markedly higher mortality than the corresponding PCE categories; the relationship was the same but less pronounced in the other categories (Figure 1B).

Conclusion

In this real-world cohort, most people with CKD had a lower 10-year estimated ASCVD risk using PREVENT equations compared to PCEs, with excellent discrimination for mortality. Identifying new cut-off points for risk categories with the PREVENT equations in the future will help ascertain eligibility for cardiovascular protective therapies that align with absolute CVD risk.

Figure 1a and 1b.

Funding

• Other NIH Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025fae5zd2h