Recently published in BMC Nephrology, an article by Ali et al. deals with the application of the Renal Failure Risk Equation (KFRE) to various etiologies of renal disease and its application in clinical practice. The clinical utility of the renal failure risk equation is of interest for planning in advanced chronic kidney disease. In our next BMC Nephrology blog becomes blog editor Dr. Daphne Knicely discuss how best to apply this equation in your clinical practice.

The Renal Failure Risk Equation (KFRE) was first proposed by Tangri. rated et al. in 2011. It was then evaluated in 2016 on a multinational basis. I often use their online calculator to advise my patients in the clinic, but more as information to alleviate patient concerns rather than to advance clinical practice. The KFRE predicts the 2- and 5-year risk of end-stage kidney disease (ESKD) in patients with chronic kidney disease (CKD) stages 3a-5. There are two forms of the equation: 4-variable and 8-variable. The 4 variable includes age, gender, estimated glomerular filtration rate (eGFR), and albuminuria. Variable 8 contains these components, but also contains serum calcium, phosphate, albumin and bicarbonate.

Ali et al. the KFRE in advanced CKD considering the causes of CKD (diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, autosomal dominant polycystic kidney disease (ADPKD), and other causes) validates appropriate discrimination and calibration. What I found very interesting was that the KFRE provides better clinical benefit for decision making like pre-ESKD planning than basing it on GFR limits alone. We usually start planning for transplant assessments, dialysis training, and dialysis access placement etc when the eGFR is <30 ml / min / 1.73 m2 (<20 and <15 ml / min / 1.73 m2 were used in this study) . et al., they identified more patients likely to progression to ESKD and delayed in others using KFRE thresholds of> 40% for 2-year risk and> 50% for 5-year risk of ESKD.

Identification of patients who progress to ESKD is maintained in planning for dialysis modality, access placement, and graft referral. If we can capture individuals early and initiate the process, there will be fewer hospital admissions and poor outcomes. Other studies looked at the use of the KFRE in the need for nephrology referrals and its use as a risk-based approach to guiding the treatment of CKD.

Based on my review of the literature and Ali et alIn the article by. I will definitely start using the KFRE in my clinical evaluation and planning for patients with advanced CRF. Perhaps it will help identify those patients who will benefit from early transplant referral and access placement, or at least early education efforts for these patients. I can only see positive things when using the KFRE as another clinical tool.

What other possible uses of the KFRE in your practice?

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The members of the SDG editorial board of the BMC series: Sheryl Hendriks

June 10, 2021

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