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Kidney Week

Abstract: PO0449

The Kidney Failure Risk Equation: Testing Previous eGFR Slopes, Clinical Variables, and Novel Populations

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Grams, Morgan, CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Brunskill, Nigel J., CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Wang, Angela Yee Moon, CKD Prognosis Consortium, Baltimore, Maryland, United States
  • Tangri, Navdeep, CKD Prognosis Consortium, Baltimore, Maryland, United States

Group or Team Name

  • CKD Prognosis Consortium
Background

The 4-variable kidney failure risk equation (KFRE) is a well-validated tool that accurately predicts the 2- and 5-year risk of kidney failure in patients with eGFR <60 ml/min/1.73 m2 using baseline eGFR, ACR, age, and sex. The aim of this study was two-fold: to assess whether KFRE can be improved using previous eGFR slope or other variables; and to evaluate whether the KFRE can be used in patients with eGFR ≥60 ml/min/1.73 m2.

Methods

We used 36 cohorts in development and 17 cohorts in validation to accomplish these aims; all cohorts participate in the CKD-Prognosis Consortium and had data on the four variables, previous 2-year eGFR slope, and at least 25 ESKD events.

Results

There were 205,004 participants with eGFR <60 ml/min/1.73 m2 (12,794 ESKD events) and 441,915 participants with eGFR ≥60 ml/min/1.73 m2 (1,220 ESKD events). In the eGFR <60 group, previous 2-year eGFR loss >3 ml/min/1.73 m2/year was associated with ESKD (meta-analyzed HR 1.36, 95% CI: 1.19-1.56) with a small improvement over the 4-variable model (baseline c-statistic in validation cohorts, 0.87-0.95; meta-analyzed difference in c-statistic in validation cohorts when adding slope, 0.001, 95% CI: 0.000-0.002). Using previous 5-year slope resulted in slightly better c-statistic compared to the model using 2-year slope (meta-analyzed difference in c-statistic in validation cohorts, 0.003, 95% CI: 0.001-0.005). Other approaches, such as using 1-year average eGFR or 1-year average ACR as inputs in the 4-variable KFRE, or incorporating black race, heart failure, or atrial fibrillation, did not result in meaningful improvements. The KFRE had poor discrimination and calibration in the eGFR ≥60 ml/min/1.73 m2 population. In a model that instead predicted 40% decline in eGFR and included age, sex, ACR, diabetes, hypertension, heart failure, and coronary heart disease, previous eGFR loss > 3 ml/min/1.73 m2/year over 2- and 5-years were associated with greater risk (HR, 1.43, 95%CI: 1.19-1.70; 1.84, 95%CI: 1.40-2.42).

Conclusion

In summary, the KFRE was improved only slightly by the inclusion of previous eGFR slope. For populations with eGFR >60, a more relevant and predictable outcome may be percent eGFR decline.

Funding

  • NIDDK Support