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Kidney Week

Abstract: TH-PO381

Application of the Kidney Failure Risk Equation to an Electronic Health Record-Based CKD Registry

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Ahmed, Salman, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Mendu, Mallika L., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Curhan, Gary C., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

The Kidney Failure Risk Equation (KFRE), utilizes age, sex, estimated glomerular filtration rate (eGFR), and urine albumin to creatinine ratio (UACR), to predict progression to End Stage Renal Disease (ESRD). Application of the KFRE to an electronic health record (EHR)-based chronic kidney disease (CKD) registry enables ESRD risk stratification across a CKD population.

Methods

Cross-sectional study of 57,385 patients included in the Partners Healthcare System (PHS) CKD registry (dialysis and transplant patients were excluded). Multivariate logistic regression analyses were conducted to identify factors associated with: UACR testing; arteriovenous fistula (AVF) and placement; kidney transplant referral; and completion of advance directives.

Results

17,266 (30%) patients had all variables required for KFRE; 40,119 (70%) patients lacked UACR. Factors associated with UACR testing were diabetes, hypertension, obesity, and being seen by an in-network nephrologist. In the highest KFRE risk stratum (≥ 40% risk of ESRD within two years; N=515), 35 (6.8%) patients had an AVF; 64 (12.4%) patients had been referred for transplantation; and 61 (11.8%) patients had advanced directives. Factors associated with not having an AVF were older age, female sex, and fewer visits to an in-network nephrologist. Factors associated with lack of transplant referral were older age, higher eGFR, and not having a PHS nephrologist. Factors associated with lack of advance directives were younger age, male sex, not having a PHS Primary Care Provider, and KFRE stratum of lowest (<3% risk) or low (3-9.9% risk).

Conclusion

The KFRE stratifies risk of ESRD; however, 70% of our patients with CKD lack UACR testing. Institution-wide UACR testing will facilitate care optimization. Our findings enable targeted care of sub-populations to improve care delivery and transition to ESRD.

Risk stratification adapted from Tangri NDT 2017, with performance on metrics per stratum applied to PHS CKD Registry.

Funding

  • NIDDK Support