Validation of the Kidney Failure Risk Equation in Manitoba

Whitlock, Reid; Chartier, Mariette; Komenda, Paul; Hingwala, Jay; Rigatto, Claudio; Walld, Randy; Dart, Allison; Tangri, Navdeep

doi:10.1177/2054358117705372

Cited by 33 publications

(47 citation statements)

References 36 publications

(41 reference statements)

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“…The statistical threshold had the highest summation of the sensitivity and specificity. We compared the statistical KFRE thresholds identified in the current population to the 3, 5, and 10% at 5 years [17, 22] and 20 and 40% at 2 years [17], and also compared KFRE-based criteria to eGFR 30–60 ml/min/1.73m 2 at 5 years and 20 ml/min/1.73m 2 at 2 years suggested by Tangri et al [42]. We also compared KFRE thresholds with eGFRs that captured the same proportions of patients in this population to test the robustness of the results.…”

Section: Methodsmentioning

confidence: 99%

“…In 2011, a predictive model called the Kidney Failure Risk Equation (KFRE) incorporating four variables (age, sex, eGFR, urine albumin-to-creatinine ratio [ACR]) or eight variables (age, sex, eGFR, ACR, serum calcium, phosphate, bicarbonate, and albumin) [16] was developed with excellent predictive performance for ESKD risk in a Canadian population [16]. Subsequently, the Original KFRE equation has been validated in more than 30 countries [17–22], recalibrated for non-North Americans using primarily European populations, and a Pooled KFRE equation has also been developed [17]. However, these KFRE equations were developed and evaluated primarily in patients visiting the nephrology clinics [16–18].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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BackgroundPatients 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.MethodsAll 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.ResultsThe 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.ConclusionsThe Recalibrated Pooled KFRE SEA performs better than existing KFREs and warrants implementation in primary care settings in SEA.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…CKD patients often receive suboptimal care [2], partly because identifying patients at highest risk of progression is challenging [3]. Although models to predict risk of progression have existed for many years [4, 5], the recently validated 4-variable kidney failure risk equation (KFRE) [6, 7] allows for a more accurate assessment of risk and has been implemented in a variety of clinical settings [8–11]. However, evaluation of the KFRE’s use as a tool to guide triage and care delivery for CKD patients has been limited.…”

Section: Introductionmentioning

confidence: 99%

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

et al. 2019

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Background The Kidney Failure Risk Equation (KFRE) predicts risk of progression to kidney failure and is used to guide clinical decisions for patients with chronic kidney disease (CKD). Methods The KFRE was implemented to guide access to multidisciplinary care for CKD patients in Alberta, Canada, based on their 2-year risk of kidney failure. We used a mixed methods approach to investigate patients’ and providers’ perspectives and experiences 1 year following KFRE implementation. We conducted post-implementation interviews with multidisciplinary clinic providers and with low-risk patients who transitioned from multidisciplinary to general nephrology care. We also administered pre- and post-implementation patient care experience surveys, targeting both low-risk patients discharged to general nephrology and high-risk patients who remained in the multidisciplinary clinic, and provider job satisfaction surveys. Results Twenty-seven interviews were conducted (9 patients, 1 family member, 17 providers). Five categories were identified among patients and providers: targeted care; access to resources outside the multidisciplinary clinics; self-efficacy; patient reassurance and reduced stress; and transition process for low-risk patients Two additional categories were identified among providers only: anticipated concerns and job satisfaction. Patients and providers reported that the risk-based approach allowed the clinic to target care to those most likely to experience kidney failure and most likely to benefit from multidisciplinary care. While some participants indicated the risk-based model enhanced the sustainability of the clinics, others expressed concern that care for low-risk patients discharged from multidisciplinary care, or those now considered ineligible, may be inadequate. Overall, 413 patients completed the care experience survey and 73 providers completed the workplace satisfaction survey. The majority of patients were satisfied with their care in both periods with no overall differences. When considering the responses “Always” and “Often” together versus not, there were statistically significant improvements in domains of access to care, caring staff, and safety of care. There were no differences in healthcare providers’ job satisfaction following KFRE implementation. Conclusions Patients and healthcare providers reported that the risk-based approach improved the focus of the multidisciplinary CKD clinics by targeting patients at highest risk, with survey results suggesting no difference in patient care experience or healthcare provider job satisfaction. Electronic supplementary material The online version of this article (10.1186/s12882-019-1269-2) contains supplementary material, which is available to authorized users.

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“…The KFRE, accessible at www.kidneyfailurerisk.com , has been implemented in a variety of clinical settings. 7 - 9 …”

Section: Introductionmentioning

confidence: 99%

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study

Smekal

Tam-Tham

Finlay

et al. 2018

Can J Kidney Health Dis

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Background:The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care.Objective:We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input.Methods:We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey.Results:Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback.Conclusions:We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.

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Validation of the Kidney Failure Risk Equation in Manitoba

Cited by 33 publications

References 36 publications

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

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

Patient and provider experience and perspectives of a risk-based approach to multidisciplinary chronic kidney disease care: a mixed methods study

Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study

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