Validation of the kidney failure risk equation in a Portuguese cohort

Silva, Bernardo Marques da; Charreu, José; Duarte, Inês; Outerelo, Cristina; Gameiro, Joana

doi:10.1016/j.nefro.2022.03.003

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…An additional issue is that of competing risks. Competing risks are events which either prevent the occurrence, or alter the probability of, the outcome of interest (14)(15)(16). For instance, CKD patients at risk of needing KRT are also at risk of death, with that risk increasing with age and frailty.…”

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confidence: 99%

Using the Kidney Failure Risk Equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

Maher

Teece

Major

et al. 2023

Preprint

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Background: The Kidney Failure Risk Equation (KFRE) predicts the 2- and 5-year risk of needing kidney replacement therapy (KRT) using four risk factors – age, sex, urine albumin-to-creatinine ratio (ACR), and creatinine-based estimated glomerular filtration rate (eGFR). Although the KFRE has been recalibrated in a UK cohort, this did not consider minority ethnic groups. Further validation of the KFRE in different ethnicities is a research priority. The KFRE also does not consider the competing risk of death, which may lead to overestimation of KRT risk. This study externally validates the KFRE for patients of South Asian ethnicity and compares methods for accounting for ethnicity and the competing event of death. Methods: Data were gathered from an established UK cohort containing 35,539 individuals diagnosed with chronic kidney disease. The KFRE was externally validated and updated in several ways taking into account ethnicity, using recognised methods for time-to-event data, including the competing risk of death. A clinical impact assessment compared the updated models through consideration of referrals made to secondary care. Results: The external validation showed the risk of KRT differed by ethnicity. Model validation performance improved when incorporating ethnicity and its interactions with ACR and eGFR as additional risk factors. Further, accounting for the competing risk of death improved prediction. Using a criteria of 5 year ≥5% predicted KRT risk, the competing risks model resulted in an extra 3 unnecessary referrals (0.59% increase) but identified an extra 1 KRT case (1.92% decrease) compared to the previous best model. A hybrid criteria of predicted risk using the competing risks model and ACR ≥70mg/mmol should be used in referrals to secondary care. Conclusions: The accuracy of KFRE prediction improves when updated to consider South Asian ethnicity and to account for the competing risk of death. This may reduce unnecessary referrals whilst identifying risks of KRT and could further individualise the KFRE and improve its clinical utility. Further research should consider other ethnicities.

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confidence: 99%

Using the Kidney Failure Risk Equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

Maher

Teece

Major

et al. 2023

Preprint

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Clinical Decision Support Tools in the Electronic Medical Record

Alexiuk,

Elgubtan,

Tangri

2024

Kidney International Reports

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Planning vascular access creation: The promising role of the kidney failure risk equation

et al. 2023

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Background: Planning for vascular access (VA) creation is essential in pre-dialysis patients although optimal timing for VA referral and placement is debatable. Guidelines suggest referral when eGFR is 15–20 mL/min/1.73 m2. This study aimed to validate the use of kidney failure risk equation (KFRE) in VA planning. Methods: Retrospective analysis of all adult patients with CKD who were referred for first VA placement, namely AVF or AVG, at a tertiary center, between January 2018 and December 2019. The four-variable KFRE was calculated. Start of KRT, mortality, and VA placement were assessed in a 2-year follow-up. We used Cox regression to predict KRT start and calculated the ROC curve. Results: 256 patients were included and 64.5% were male, mean age was 70.4 ± 12.9 years and mean eGFR was 16.09 ± 10.43 mL/min/1.73 m2. One hundred fifty-nine patients required KRT (62.1%) and 72 (28.1%) died in the 2-year follow-up. The KFRE accurately predicted KRT start within 2-years (38.3 ± 23.8% vs 17.6 ± 20.9%, p < 0.001; HR 1.05 95% CI (1.06–1.12), p < 0.001), with an auROC of 0.788 ( p < 0.001, 95% CI (0.733–0.837)). The optimal KFRE cut-off was >20%, with a HR of 9.2 (95% CI (5.06–16.60), p < 0.001). Patients with KFRE ⩾ 20% had a significant lower mean time from VA consult to KRT initiation (10.8 ± 9.4 vs 15.6 ± 10.3 months, p < 0.001). On a sub-analysis of patients with an eGFR < 20 mL/min/1.73 m2, a KFRE ⩾ 20% was also a significant predictor of 2-year start of KRT, with an HR of 6.61 (95% CI (3.49–12.52), p < 0.001). Conclusion: KFRE accurately predicted 2-year KRT start in this cohort of patients. A KFRE ⩾ 20% can help to establish higher priority patients for VA placement. The authors suggest referral for VA creation when eGFR < 20 mL/min/1.73 m2 and KFRE ⩾ 20%.

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Validation of the kidney failure risk equation in a Portuguese cohort

Cited by 3 publications

References 20 publications

Using the Kidney Failure Risk Equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

Using the Kidney Failure Risk Equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

Clinical Decision Support Tools in the Electronic Medical Record

Planning vascular access creation: The promising role of the kidney failure risk equation

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