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Abstract: TH-OR047

Adaptation of the Kidney Failure Risk Equation to Predict Risk of ESRD in Children

Session Information

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology


  • Ku, Elaine, UC San Francisco, San Francisco, California, United States
  • Wuehl, Elke, University of Heidelberg, Heidelberg, BW, Germany
  • Winnicki, Erica, UC San Francisco, San Francisco, California, United States
  • Mitsnefes, Mark, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Warady, Bradley A., Children's Mercy Kansas City , Kansas City, Missouri, United States
  • Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Schaefer, Franz S., University of Heidelberg, Heidelberg, BW, Germany

The Kidney Failure Risk Equations (KFREs) have been shown to predict ESRD risk in children with mild-to-moderate CKD in the US. Whether the KFRE accurately predicts progression to ESRD in children with more advanced CKD and children outside of the US is unknown. KFREs to predict ESRD risk in North American (NA) and non-North American (NNA) adults are currently available.


We studied 653 children from 4C study, 341 children from ESCAPE trial, and 633 children from CKiD study with an eGFR <60 mL/min/1.73 m2. The primary predictors were the 4-variable (age, sex, bedside eGFR, albumin-to-creatinine ratio) NA and NNA KFRE score which provides estimates of the risk of ESRD over a 2- and 5-year horizon. C-statistics were used to compare discrimination of the risk for ESRD by the KFRE, and this predicted risk of ESRD was compared to observed failure rates.


Median follow-up time was 2.8 years in 4C, 4.7 years in ESCAPE, and 3.8 years in CKiD. The NA and NNA 4-variable KFRE strongly discriminated risk of ESRD in children outside the US, with a C-statistic of 0.82 and 0.79 in 4C and 0.90 and 0.87 in ESCAPE over a 2- and 5-year horizon, respectively. The predicted risk closely matched the observed ESRD rates in CKD stage 3, but over-predicted ESRD risk in CKD stage 4-5 across all cohorts (Figure 1). After we re-calibrated the equation, performance of the KFRE in advanced CKD improved (Figure 2).


The KFRE is a simple tool that strongly discriminates the risk of ESRD in children with CKD in the US and internationally, although its performance was less robust in children with advanced CKD. With re-calibration, its performance in more advanced CKD was substantially improved.


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