Internal medicine journal · 2025
Evaluation of Kidney Failure Risk Equation score for vascular access planning in an Australian cohort.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Hong Regina, Hirsch Daniel, Li Katherine, Pirabhahar Saiyini, Turner Kylie, Ha Jeffrey Tsun Kit, Katz Ivor
Аннотация
BACKGROUND: The Kidney Failure Risk Equation (KFRE) is a validated tool for assessing the risk of progression to kidney failure requiring renal replacement therapy (RRT). A 2-year KFRE risk threshold of ≥40% may support timely vascular access planning.
AIMS: To compare the utility of KFRE with traditional estimated glomerular filtration rate (eGFR) thresholds for guiding vascular access planning in an Australian cohort.
METHODS: This single-centre observational cohort study retrospectively reviewed 580 adult patients referred to a Kidney Disease Education Clinic (KDEC) between 2016 and 2021. Among these, 211 patients who underwent dialysis access formation were analysed. Patient trajectories, including eGFR and 2-year KFRE scores at referral, access formation and dialysis initiation, were described alongside rates of emergency access.
RESULTS: Of 211 patients with access created, 204 commenced dialysis. A median 2-year KFRE of 46% predicted dialysis within 12 months, supporting its use for access planning. Compared with eGFR < 15 mL/min/1.73m2, KFRE thresholds (≥40% or ≥ 50%) better identified those at risk. A 2-year KFRE ≥ 50% offered the best balance of sensitivity (70%) and specificity (68%) for predicting dialysis within 12 months, whereas ≥40% was more accurate for forecasting dialysis at 24 months and guiding early education. Emergency access was required in 31.5% of haemodialysis patients with lower eGFR at referral (11 vs 15 mL/min/1.73 m2), higher 2-year KFRE (87% vs 62%) and more preceding hospitalisations (95.4% vs 38.5%) than others.
CONCLUSION: KFRE-based thresholds improve risk-stratified access planning compared with eGFR alone. A KFRE ≥ 40% supports early referral for modality education and vascular access, tailored to patient and institutional needs.
AIMS: To compare the utility of KFRE with traditional estimated glomerular filtration rate (eGFR) thresholds for guiding vascular access planning in an Australian cohort.
METHODS: This single-centre observational cohort study retrospectively reviewed 580 adult patients referred to a Kidney Disease Education Clinic (KDEC) between 2016 and 2021. Among these, 211 patients who underwent dialysis access formation were analysed. Patient trajectories, including eGFR and 2-year KFRE scores at referral, access formation and dialysis initiation, were described alongside rates of emergency access.
RESULTS: Of 211 patients with access created, 204 commenced dialysis. A median 2-year KFRE of 46% predicted dialysis within 12 months, supporting its use for access planning. Compared with eGFR < 15 mL/min/1.73m2, KFRE thresholds (≥40% or ≥ 50%) better identified those at risk. A 2-year KFRE ≥ 50% offered the best balance of sensitivity (70%) and specificity (68%) for predicting dialysis within 12 months, whereas ≥40% was more accurate for forecasting dialysis at 24 months and guiding early education. Emergency access was required in 31.5% of haemodialysis patients with lower eGFR at referral (11 vs 15 mL/min/1.73 m2), higher 2-year KFRE (87% vs 62%) and more preceding hospitalisations (95.4% vs 38.5%) than others.
CONCLUSION: KFRE-based thresholds improve risk-stratified access planning compared with eGFR alone. A KFRE ≥ 40% supports early referral for modality education and vascular access, tailored to patient and institutional needs.