Improving precision in prediction: Using kidney failure risk equations as a potential adjunct to vascular access planning

2018 ◽  
Vol 20 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Nicholas Inston ◽  
Charmaine E Lok
Keyword(s):  
Kidney Function ◽  
Vascular Access ◽  
Kidney Failure ◽  
Risk Equation ◽  
Risk Of Death ◽  
Failure Risk ◽  
Multiple Variables ◽  
Individualised Care ◽  
End Stage ◽  
Kidney Function Decline

The timing of referral for creation of vascular access in a patient with declining kidney function is difficult to predict. Current methods may result in patients undergoing unnecessary procedures and subsequent interventions on accesses that are never used. Multiple variables, including time for assessment, surgery and follow-up that considers the likelihood of access failure, and the estimated rate of kidney function decline, make vascular access planning challenging and difficult to balance. Better prediction tools that incorporate the risks of progressive decline in kidney function with the risk of access failure and the competing risk of death would facilitate decision-making in vascular access. The kidney failure risk equation is a validated, simple online tool that estimates the probability of the 2- and 5-year risk of reaching end-stage kidney disease. While the use of the kidney failure risk equation has not been validated as an adjunct to planning vascular access, it has potential and may facilitate more individualised care and more appropriate allocation of resources.

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

2018 ◽  
Vol 172 (2) ◽  
pp. 174 ◽  
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

scholarly journals Validation of the kidney failure risk equation for end-stage kidney disease in Southeast Asia

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yeli Wang ◽  
Francis Ngoc Hoang Long Nguyen ◽  
John C. Allen ◽  
Jasmine Quan Lan Lew ◽  
Ngiap Chuan Tan ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Brier Score ◽  
End Stage Kidney Disease ◽  
Primary Care Clinics ◽  
Risk Equation ◽  
Failure Risk ◽  
End Stage ◽  
Better Than

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.

scholarly journals SUN-123 VALIDATION AND RECALIBRATION OF THE KIDNEY FAILURE RISK EQUATION FOR END-STAGE KIDNEY DISEASE IN SOUTHEAST ASIA

2020 ◽  
Vol 5 (3) ◽  
pp. S252
Author(s):  
Y. Wang ◽  
F.N.H.L. Nguyen ◽  
J. Allen ◽  
J.Q.L. Lew ◽  
N.C. Tan ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Southeast Asia ◽  
Kidney Failure ◽  
End Stage Kidney Disease ◽  
Risk Equation ◽  
Failure Risk ◽  
End Stage

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

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.

scholarly journals External Validation of the Kidney Failure Risk Equation and Re-Calibration with Addition of Ultrasound Parameters

2016 ◽  
Vol 11 (4) ◽  
pp. 609-615 ◽  
Author(s):  
Claudia S. Lennartz ◽  
John William Pickering ◽  
Sarah Seiler-Mußler ◽  
Lucie Bauer ◽  
Kathrin Untersteller ◽  
...  
Keyword(s):  
Kidney Failure ◽  
External Validation ◽  
Risk Equation ◽  
Failure Risk ◽  
Ultrasound Parameters

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

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

scholarly journals Validation of the Kidney Failure Risk Equation in Manitoba

2017 ◽  
Vol 4 ◽  
pp. 205435811770537 ◽  
Author(s):  
Reid H. Whitlock ◽  
Mariette Chartier ◽  
Paul Komenda ◽  
Jay Hingwala ◽  
Claudio Rigatto ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Risk Equation ◽  
Failure Risk

scholarly journals Influence of Mortality on Estimating the Risk of Kidney Failure in People with Stage 4 CKD

2019 ◽  
Vol 30 (11) ◽  
pp. 2219-2227 ◽  
Author(s):  
Pietro Ravani ◽  
Marta Fiocco ◽  
Ping Liu ◽  
Robert R. Quinn ◽  
Brenda Hemmelgarn ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Failure ◽  
Absolute Risk ◽  
Population Based ◽  
Comparison Standard ◽  
Risk Of Death ◽  
Failure Risk ◽  
Stage 4 ◽  
Standard Risk ◽  
Over Time

BackgroundMost kidney failure risk calculators are based on methods that censor for death. Because mortality is high in people with severe, nondialysis-dependent CKD, censoring for death may overestimate their risk of kidney failure.MethodsUsing 2002–2014 population-based laboratory and administrative data for adults with stage 4 CKD in Alberta, Canada, we analyzed the time to the earliest of kidney failure, death, or censoring, using methods that censor for death and methods that treat death as a competing event factoring in age, sex, diabetes, cardiovascular disease, eGFR, and albuminuria. Stage 4 CKD was defined as a sustained eGFR of 15–30 ml/min per 1.73 m2.ResultsOf the 30,801 participants (106,447 patient-years at risk; mean age 77 years), 18% developed kidney failure and 53% died. The observed risk of the combined end point of death or kidney failure was 64% at 5 years and 87% at 10 years. By comparison, standard risk calculators that censored for death estimated these risks to be 76% at 5 years and >100% at 7.5 years. Censoring for death increasingly overestimated the risk of kidney failure over time from 7% at 5 years to 19% at 10 years, especially in people at higher risk of death. For example, the overestimation of 5-year absolute risk ranged from 1% in a woman without diabetes, cardiovascular disease, or albuminuria and with an eGFR of 25 ml/min per 1.73 m2 (9% versus 8%), to 27% in a man with diabetes, cardiovascular disease, albuminuria >300 mg/d, and an eGFR of 20 ml/min per 1.73 m2 (78% versus 51%).ConclusionsKidney failure risk calculators should account for death as a competing risk to increase their accuracy and utility for patients and providers.

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

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.

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