TY - JOUR
T1 - The Kidney Failure Risk Equation
T2 - Evaluation of Novel Input Variables including eGFR Estimated Using the CKD-EPI 2021 Equation in 59 Cohorts
AU - Grams, Morgan E.
AU - Brunskill, Nigel J.
AU - Ballew, Shoshana H.
AU - Sang, Yingying
AU - Coresh, Josef
AU - Matsushita, Kunihiro
AU - Surapaneni, Aditya
AU - Bell, Samira
AU - Carrero, Juan J.
AU - Chodick, Gabriel
AU - Evans, Marie
AU - Heerspink, Hiddo J.L.
AU - Inker, Lesley A.
AU - Iseki, Kunitoshi
AU - Kalra, Philip A.
AU - Kirchner, H. Lester
AU - Lee, Brian J.
AU - Levin, Adeera
AU - Major, Rupert W.
AU - Medcalf, James
AU - Nadkarni, Girish N.
AU - Naimark, David M.J.
AU - Ricardo, Ana C.
AU - Sawhney, Simon
AU - Sood, Manish M.
AU - Staplin, Natalie
AU - Stempniewicz, Nikita
AU - Stengel, Benedicte
AU - Sumida, Keiichi
AU - Traynor, Jamie P.
AU - Van Den Brand, Jan
AU - Wen, Chi Pang
AU - Woodward, Mark
AU - Yang, Jae Won
AU - Wang, Angela Yee Moon
AU - Tangri, Navdeep
N1 - Publisher Copyright: © 2023 American Society of Nephrology. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Significance StatementThe kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict 2- and 5-year risk of kidney failure in populations with eGFR <60 ml/min per 1.73 m2. However, the CKD-EPI 2021 creatinine equation for eGFR is now recommended for use but has not been fully tested in the context of KFRE. In 59 cohorts comprising 312,424 patients with CKD, the authors assessed the predictive performance and calibration associated with the use of the CKD-EPI 2021 equation and whether additional variables and accounting for the competing risk of death improves the KFRE's performance. The KFRE generally performed well using the CKD-EPI 2021 eGFR in populations with eGFR <45 ml/min per 1.73 m2and was not improved by adding the 2-year prior eGFR slope and cardiovascular comorbidities.BackgroundThe kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict kidney failure risk in people with GFR <60 ml/min per 1.73 m2.MethodsUsing 59 cohorts with 312,424 patients with CKD, we tested several modifications to the KFRE for their potential to improve the KFRE: using the CKD-EPI 2021 creatinine equation for eGFR, substituting 1-year average ACR for single-measure ACR and 1-year average eGFR in participants with high eGFR variability, and adding 2-year prior eGFR slope and cardiovascular comorbidities. We also assessed calibration of the KFRE in subgroups of eGFR and age before and after accounting for the competing risk of death.ResultsThe KFRE remained accurate and well calibrated overall using the CKD-EPI 2021 eGFR equation. The other modifications did not improve KFRE performance. In subgroups of eGFR 45-59 ml/min per 1.73 m2and in older adults using the 5-year time horizon, the KFRE demonstrated systematic underprediction and overprediction, respectively. We developed and tested a new model with a spline term in eGFR and incorporating the competing risk of mortality, resulting in more accurate calibration in those specific subgroups but not overall.ConclusionsThe original KFRE is generally accurate for eGFR <45 ml/min per 1.73 m2when using the CKD-EPI 2021 equation. Incorporating competing risk methodology and splines for eGFR may improve calibration in low-risk settings with longer time horizons. Including historical averages, eGFR slopes, or a competing risk design did not meaningfully alter KFRE performance in most circumstances.
AB - Significance StatementThe kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict 2- and 5-year risk of kidney failure in populations with eGFR <60 ml/min per 1.73 m2. However, the CKD-EPI 2021 creatinine equation for eGFR is now recommended for use but has not been fully tested in the context of KFRE. In 59 cohorts comprising 312,424 patients with CKD, the authors assessed the predictive performance and calibration associated with the use of the CKD-EPI 2021 equation and whether additional variables and accounting for the competing risk of death improves the KFRE's performance. The KFRE generally performed well using the CKD-EPI 2021 eGFR in populations with eGFR <45 ml/min per 1.73 m2and was not improved by adding the 2-year prior eGFR slope and cardiovascular comorbidities.BackgroundThe kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict kidney failure risk in people with GFR <60 ml/min per 1.73 m2.MethodsUsing 59 cohorts with 312,424 patients with CKD, we tested several modifications to the KFRE for their potential to improve the KFRE: using the CKD-EPI 2021 creatinine equation for eGFR, substituting 1-year average ACR for single-measure ACR and 1-year average eGFR in participants with high eGFR variability, and adding 2-year prior eGFR slope and cardiovascular comorbidities. We also assessed calibration of the KFRE in subgroups of eGFR and age before and after accounting for the competing risk of death.ResultsThe KFRE remained accurate and well calibrated overall using the CKD-EPI 2021 eGFR equation. The other modifications did not improve KFRE performance. In subgroups of eGFR 45-59 ml/min per 1.73 m2and in older adults using the 5-year time horizon, the KFRE demonstrated systematic underprediction and overprediction, respectively. We developed and tested a new model with a spline term in eGFR and incorporating the competing risk of mortality, resulting in more accurate calibration in those specific subgroups but not overall.ConclusionsThe original KFRE is generally accurate for eGFR <45 ml/min per 1.73 m2when using the CKD-EPI 2021 equation. Incorporating competing risk methodology and splines for eGFR may improve calibration in low-risk settings with longer time horizons. Including historical averages, eGFR slopes, or a competing risk design did not meaningfully alter KFRE performance in most circumstances.
KW - albuminuria
KW - chronic kidney disease
KW - glomerular filtration rate
KW - kidney failure
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85149428092&partnerID=8YFLogxK
U2 - https://doi.org/10.1681/ASN.0000000000000050
DO - https://doi.org/10.1681/ASN.0000000000000050
M3 - مقالة
C2 - 36857500
SN - 1046-6673
VL - 34
SP - 482
EP - 494
JO - Journal Of The American Society Of Nephrology
JF - Journal Of The American Society Of Nephrology
IS - 3
ER -