FP118THE KIDNEY FAILURE RISK EQUATION IN PRIMARY CARE CKD – AN INDEPENDENT, EXTERNAL VALIDATION AND CLINICAL IMPACT STUDY

Abstract Background Patients with chronic kidney disease (CKD) are at high risk of end-stage kidney disease (ESKD). The Kidney Failure Risk Equation (KFRE), which predicts ESKD risk among patients with CKD, has not been validated in primary care clinics in Southeast Asia (SEA). Therefore, we aimed to (1) evaluate the performance of existing KFRE equations, (2) recalibrate KFRE for better predictive precision, and (3) identify optimally feasible KFRE thresholds for nephrologist referral and dialysis planning in SEA. Methods All patients with CKD visiting nine primary care clinics from 2010 to 2013 in Singapore were included and applied 4-variable KFRE equations incorporating age, sex, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR). ESKD onset within two and five years were acquired via linkage to the Singapore Renal Registry. A weighted Brier score (the squared difference between observed vs predicted ESKD risks), bias (the median difference between observed vs predicted ESKD risks) and precision (the interquartile range of the bias) were used to select the best-calibrated KFRE equation. Results The recalibrated KFRE (named Recalibrated Pooled KFRE SEA) performed better than existing and other recalibrated KFRE equations in terms of having a smaller Brier score (square root: 2.8% vs. 4.0–9.3% at 5 years; 2.0% vs. 6.1–9.1% at 2 years), less bias (2.5% vs. 3.3–5.2% at 5 years; 1.8% vs. 3.2–3.6% at 2 years), and improved precision (0.5% vs. 1.7–5.2% at 5 years; 0.5% vs. 3.8–4.2% at 2 years). Area under ROC curve for the Recalibrated Pooled KFRE SEA equations were 0.94 (95% confidence interval [CI]: 0.93 to 0.95) at 5 years and 0.96 (95% CI: 0.95 to 0.97) at 2 years. The optimally feasible KFRE thresholds were > 10–16% for 5-year nephrologist referral and > 45% for 2-year dialysis planning. Using the Recalibrated Pooled KFRE SEA, an estimated 82 and 89% ESKD events were included among 10% of subjects at highest estimated risk of ESKD at 5-year and 2-year, respectively. Conclusions The Recalibrated Pooled KFRE SEA performs better than existing KFREs and warrants implementation in primary care settings in SEA.

Download Full-text

A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom

BMC Nephrology ◽

10.1186/s12882-021-02259-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ibrahim Ali ◽

Philip A. Kalra

Keyword(s):

United Kingdom ◽

Kidney Failure ◽

Graft Failure ◽

Risk Scores ◽

Transplant Recipients ◽

Good Discrimination ◽

Risk Equation ◽

The United Kingdom ◽

Failure Risk ◽

Risk Patients

Abstract Background There is emerging evidence that the 4-variable Kidney Failure Risk Equation (KFRE) can be used for risk prediction of graft failure in transplant recipients. However, geographical validation of the 4-variable KFRE in transplant patients is lacking, as is whether the more extensive 8-variable KFRE improves predictive accuracy. This study aimed to validate the 4- and 8-variable KFRE predictions of the 5-year death-censored risk of graft failure in patients in the United Kingdom. Methods A retrospective cohort study involved 415 transplant recipients who had their first renal transplant between 2003 and 2015 and were under follow-up at Salford Royal NHS Foundation Trust. The KFRE risk scores were calculated on variables taken 1-year post-transplant. The area under the receiver operating characteristic curves (AUC) and calibration plots were evaluated to determine discrimination and calibration of the 4- and 8-variable KFREs in the whole cohort as well as in a subgroup analysis of living and deceased donor recipients and in patients with an eGFR< 45 ml/min/1.73m2. Results There were 16 graft failure events (4%) in the whole cohort. The 4- and 8-variable KFREs showed good discrimination with AUC of 0.743 (95% confidence interval [CI] 0.610–0.876) and 0.751 (95% CI 0.629–0.872) respectively. In patients with an eGFR< 45 ml/min/1.73m2, the 8-variable KFRE had good discrimination with an AUC of 0.785 (95% CI 0.558–0.982) but the 4-variable provided excellent discrimination in this group with an AUC of 0.817 (0.646–0.988). Calibration plots however showed poor calibration with risk scores tending to underestimate risk of graft failure in low-risk patients and overestimate risk in high-risk patients, which was seen in the primary and subgroup analyses. Conclusions Despite adequate discrimination, the 4- and 8-variable KFREs are imprecise in predicting graft failure in transplant recipients using data 1-year post-transplant. Larger, international studies involving diverse patient populations should be considered to corroborate these findings.

Download Full-text

The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

Kidney Medicine ◽

10.1016/j.xkme.2021.08.010 ◽

2021 ◽

Author(s):

Salman Ahmed ◽

Suraj Sarvode Mothi ◽

Thomas Sequist ◽

Navdeep Tangri ◽

Roaa M. Khinkar ◽

...

Keyword(s):

Kidney Failure ◽

Care Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Risk Equation ◽

Failure Risk

Download Full-text

Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease

JAMA Pediatrics ◽

10.1001/jamapediatrics.2017.4083 ◽

2018 ◽

Vol 172 (2) ◽

pp. 174 ◽

Cited By ~ 16

Author(s):

Erica Winnicki ◽

Charles E. McCulloch ◽

Mark M. Mitsnefes ◽

Susan L. Furth ◽

Bradley A. Warady ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Kidney Failure ◽

End Stage Renal Disease ◽

Risk Equation ◽

Failure Risk ◽

Risk Of Progression ◽

Stage Renal Disease ◽

End Stage

Download Full-text

Validation of the Kidney Failure Risk Equation in Manitoba

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358117705372 ◽

2017 ◽

Vol 4 ◽

pp. 205435811770537 ◽

Cited By ~ 7

Author(s):

Reid H. Whitlock ◽

Mariette Chartier ◽

Paul Komenda ◽

Jay Hingwala ◽

Claudio Rigatto ◽

...

Keyword(s):

Kidney Failure ◽

Risk Equation ◽

Failure Risk

Download Full-text

Performance of the Kidney Failure Risk Equation by Disease Etiology in Advanced CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03940320 ◽

2020 ◽

Vol 15 (10) ◽

pp. 1424-1432

Author(s):

Gregory L. Hundemer ◽

Navdeep Tangri ◽

Manish M. Sood ◽

Tim Ramsay ◽

Ann Bugeja ◽

...

Keyword(s):

Kidney Disease ◽

Confidence Interval ◽

Kidney Failure ◽

Operating Characteristic ◽

Area Under The Curve ◽

Polycystic Kidney ◽

Receiver Operating Characteristic Curves ◽

Time Points ◽

Risk Equation ◽

Failure Risk

Background and objectivesThe kidney failure risk equation is a clinical tool commonly used for prediction of progression from CKD to kidney failure. The kidney failure risk equation’s accuracy in advanced CKD and whether this varies by CKD etiology remains unknown. This study examined the kidney failure risk equation’s discrimination and calibration at 2 and 5 years among a large tertiary care population with advanced CKD from heterogeneous etiologies.Design, setting, participants, & measurementsThis retrospective cohort study included 1293 patients with advanced CKD (median eGFR 15 ml/min per 1.73 m2) referred to the Ottawa Hospital Multi-Care Kidney Clinic between 2010 and 2016, with follow-up clinical data available through 2018. Four-variable kidney failure risk equation scores for 2- and 5-year risks of progression to kidney failure (defined as dialysis or kidney transplantation) were calculated upon initial referral and correlated with the subsequent observed kidney failure incidence within these time frames. Receiver operating characteristic curves and calibration plots were used to measure the discrimination and calibration of the kidney failure risk equation both in the overall advanced CKD population and by CKD etiology: diabetic kidney disease, hypertensive nephrosclerosis, GN, polycystic kidney disease, and other. Pairwise comparisons of the receiver operating characteristic curves by CKD etiology were performed to compare kidney failure risk equation discrimination.ResultsThe kidney failure risk equation provided adequate to excellent discrimination in identifying patients with CKD likely to progress to kidney failure at the 2- and 5-year time points both overall (2-year area under the curve, 0.83; 95% confidence interval, 0.81 to 0.85; 5-year area under the curve, 0.81; 95% confidence interval, 0.77 to 0.84) and across CKD etiologies. The kidney failure risk equation displayed adequate calibration at the 2- and 5-year time points both overall and across CKD etiologies (Hosmer–Lemeshow P≥0.05); however, the predicted risks of kidney failure were higher than the observed risks across CKD etiologies with the exception of polycystic kidney disease.ConclusionsThe kidney failure risk equation provides adequate discrimination and calibration in advanced CKD and across CKD etiologies.

Download Full-text

Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽

10.1136/bmjopen-2018-027315 ◽

2019 ◽

Vol 9 (6) ◽

pp. e027315 ◽

Cited By ~ 1

Author(s):

Harjeet Kaur Bhachu ◽

Paul Cockwell ◽

Anuradhaa Subramanian ◽

Krishnarajah Nirantharakumar ◽

Derek Kyte ◽

...

Keyword(s):

Primary Care ◽

Kidney Disease ◽

Secondary Care ◽

Health Improvement ◽

Cross Sectional ◽

Risk Equation ◽

Failure Risk ◽

The Health Improvement Network ◽

The Uk ◽

The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

Download Full-text