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Abstract: FR-PO926

Five-Year Risk of ESKD in the US Population: Implications for Kidney Care Referral

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Tio, Maria Clarissa, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Talluri, Rajesh, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Syed, Aliba, University of California Irvine, Irvine, California, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Sriperumbuduri, Sriram, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Obi, Yoshitsugu, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Hall, Michael, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Shafi, Tariq, University of Mississippi Medical Center, Jackson, Mississippi, United States
Background

CKD definition and stratification are based on eGFR and albuminuria as both relate to the risk of ESKD. Unlike eGFR, the Kidney Failure Risk Equation (KFRE) was specifically developed to predict the risk of ESKD. However, the distribution of this risk in the US population is unknown.

Methods

We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES; N=8,016), to calculate the 5-year ESKD risk using the 8-variable KFRE among adults with CKD (either an ACR >30mg/g or eGFR [CKD-EPI 2021] <60mL/min/1.73m2). We categorized the 5-year ESKD risk as <1%, 1-4.9%, 5-9.9%, and ≥10% and compared its distribution across CKD stages. We also calculated the US population eligible for nephrology evaluation using two of the UK National Institute for Health and Care Excellence (NICE) 2021 criteria (ESKD risk ≥5% or ACR ≥600 mg/g).

Results

The prevalence of CKD was 14% in the US. The mean age of US CKD population was 60 years and 57% were female. Of the 31.1 million US adults classified as CKD, 25 million (81%) had a <1% risk (Table 1); 2 million (7%) had a ≥5% risk of ESKD in 5 years. In CKD stage G3A with ACR <30 mg/g, the median [interquartile range] 5-year ESKD risk was 0.5% [0.36%-0.75%] and none had a risk of >5%. Using the NICE criteria, 3.2 million (10.4%) of those with CKD warrant referral for nephrology care.

Conclusion

Calculation of 5-year ESKD risk can help identify and prioritize patients that need nephrology care. The 5-year ESKD risk should be incorporated in the definition, categorization, and Nephrology referral recommendations for CKD.

Funding

  • Other NIH Support