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 The Kidney Failure Risk Equation for Prediction of Allograft Loss in Kidney Transplant Recipients

2020 ◽  
Vol 2 (6) ◽  
pp. 753-761.e1
Author(s):  
Chi D. Chu ◽  
Elaine Ku ◽  
Mohammad Kazem Fallahzadeh ◽  
Charles E. McCulloch ◽  
Delphine S. Tuot
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Risk Equation ◽  
Failure Risk ◽  
Allograft Loss

scholarly journals Accuracy of Kidney Failure Risk Equation in Transplant Recipients

2019 ◽  
Vol 4 (9) ◽  
pp. 1334-1337 ◽  
Author(s):  
Shareef Akbari ◽  
Greg Knoll ◽  
Christine A. White ◽  
Teerath Kumar ◽  
Todd Fairhead ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Transplant Recipients ◽  
Risk Equation ◽  
Failure Risk

scholarly journals Validation of the Kidney Failure Risk Equation in Kidney Transplant Recipients

2020 ◽  
Vol 7 ◽  
pp. 205435812092262 ◽  
Author(s):  
Navdeep Tangri ◽  
Thomas W. Ferguson ◽  
Chris Wiebe ◽  
Frederick Eng ◽  
Michelle Nash ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Characteristic Curve ◽  
Transplant Recipients ◽  
Clinical Implementation ◽  
Kidney Transplant Recipients ◽  
Risk Equation ◽  
Failure Risk ◽  
Allograft Failure ◽  
C Statistic

Background: Predicting allograft failure in kidney transplant recipients can help plan renal replacement therapy and guide patient-provider communication. The kidney failure risk equation (KFRE) accurately predicts the need for dialysis in patients with chronic kidney disease (CKD), but has not been validated in kidney transplant recipients. Objective: We sought to validate the 4-variable KFRE (age, sex, estimated glomerular filtration rate [eGFR], and urine albumin-to-creatinine ratio [ACR]) for prediction of 2- and 5-year death-censored allograft failure. Design: Retrospective cohort study. Setting: Four independent North American Cohorts from Ontario, Canada; Alberta, Canada; Manitoba, Canada; and Wisconsin, United States, between January 1999 and December 2017. Patients: Adult kidney transplant patients at 1-year posttransplantation. Measurements: Kidney failure risk as measured by the KFRE (eGFR, urine ACR, age, and sex). Methods: We included all adult patients who had at least 1 serum creatinine and at least 1 urine ACR measurement approximately 1 year following kidney transplantation. The performance of the KFRE was evaluated using the area under the receiver operating characteristic curve (C-statistic). C-statistics from the 4 cohorts were meta-analyzed using random-effects models. Results: A total of 3659 patients were included. Pooled C-statistics were good in the entire population, at 0.81 (95% confidence interval: 0.72-0.91) for the 2-year KFRE and 0.73 (0.67-0.80) for the 5-year KFRE. Discrimination improved among patients with poorer kidney function (eGFR < 45 mL/min/1.73 m2), with a C-statistic of 0.88 (0.78-0.98) for the 2-year KFRE and 0.83 (0.74-0.91) for the 5-year KFRE. Limitations: The KFRE does not predict episodes of acute rejection and there was heterogeneity between cohorts. Conclusions: The KFRE accurately predicts kidney failure in kidney transplant recipients at 1-year posttransplantation. Further validation in larger cohorts with longer follow-up times can strengthen the case for clinical implementation.

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 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 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 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.

scholarly journals Estimating kidney failure risk using electronic medical records

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005592020
Author(s):  
Felipe S. Naranjo ◽  
Yingying Sang ◽  
Shoshana H. Ballew ◽  
Nikita Stempniewicz ◽  
Stephan C. Dunning ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Kidney Failure ◽  
Medical Records ◽  
Individual Risk ◽  
Systematic Bias ◽  
Risk Equation ◽  
Protein Levels ◽  
Urine Dipstick ◽  
Urine Albumin ◽  
Failure Risk

Background: The 4-variable kidney failure risk equation (KFRE) is a well-validated tool for patients with GFR <60 ml/min/1.73 m2 that incorporates age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to forecast individual risk of kidney failure. Implementing the KFRE in the electronic medical record is challenging, however, due to low ACR testing in clinical practice. The aim of this study was to determine, when ACR is missing, whether to impute ACR from PCR or dipstick protein for use in the 4-variable KFRE or to use the 3-variable KFRE that does not require ACR. Methods: Using electronic health records from OptumLabs® Data Warehouse, patients with eGFR <60 ml/min/1.73 m2 were categorized based on the availability of ACR testing within the previous 3 years. For patients missing ACR, we extracted urine protein-to-creatinine (PCR) and dipstick protein results, comparing the discrimination of the 3-variable KFRE (age, sex, GFR) with the 4-variable KFRE estimated using imputed ACR from PCR and dipstick protein levels. Results: There were 976,299 patients in 39 health care organizations; 59.0% were women, mean age was 72 years and mean eGFR was 47 ml/min/1.73m2. The proportion with ACR testing was 19.3% within the previous 3 years. An additional 1.7% had an available PCR and 36.3% had a dipstick protein; the remaining 42.8% had no form of albuminuria testing. The 4-variable KFRE had significantly better discrimination than the 3-variable KFRE among patients with ACR testing, PCR testing and urine dipstick protein levels, even with imputed ACR for the latter two groups. Calibration of the 4-variable KFRE was acceptable in each group, but the 3-variable equation showed systematic bias in the groups that lacked ACR or PCR testing. Conclusion: Implementation of the KFRE in electronic medical records should incorporate ACR even if only imputed from PCR or urine dipstick protein levels.

scholarly journals Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

2021 ◽  
pp. CJN.06770521 ◽  
Author(s):  
Bhanu Prasad ◽  
Meric Osman ◽  
Maryam Jafari ◽  
Lexis Gordon ◽  
Navdeep Tangri ◽  
...  
Keyword(s):  
High Risk ◽  
Prescription Drugs ◽  
Kidney Failure ◽  
Hospital Admissions ◽  
Low Risk ◽  
Content Type ◽  
Physician Visits ◽  
Risk Equation ◽  
Risk Of Progression ◽  
Risk Patients

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

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