Kidney Week

Abstract: TH-PO300

Kidney Failure Risk Equation for Vascular Access Planning: A Nationwide Observational Cohort Study From Sweden

Session Information

• Vascular Access: From Biology to Managing Complications
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Vascular Access

Authors

• Hahn Lundström, Ulrika, Karolinska Institutet, Stockholm, Stockholm, Sweden

Ulrika Hahn Lundström,

• Ramspek, Chava L., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands

Chava L. Ramspek,

• Dekker, Friedo W., Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands

Friedo W. Dekker,

• Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Stockholm, Sweden

Juan Jesus Carrero,

• Hedin, Ulf, Karolinska Institutet, Stockholm, Stockholm, Sweden

Ulf Hedin,

• Evans, Marie, Karolinska Institutet, Stockholm, Stockholm, Sweden

Marie Evans,

Background

The optimal timing of arteriovenous (AV) access creation remains a challenge. Our aim was to study if a Kidney Failure Risk Equation (KFRE) threshold would improve AV access planning.

Methods

From 28,798 patients included in the Swedish Renal Registry-chronic kidney disease 2008-2020 we generated two cohorts; first visit when KFRE was >40% (KFRE40), and first visit when estimated glomerular filtration rate (eGFR)<15 ml/min/1.73m² (eGFR15). The cohorts were followed until start of kidney replacement therapy (KRT) and death, the proportion of patients starting hemodialysis with a working access and test diagnostics for the two methods were described.

Results

The eGFR decline was faster in KFRE40 compared to the eGFR15 (-2.0 vs -0.95 ml/min/1.73m2 per year). KFRE40 had superior positive predictive value for KRT initiation at 2 years (56% versus 43% for eGFR15). KFRE40 had higher specificity (90% versus 79% for eGFR15), while eGFR15 had higher sensitivity (88% versus 75% for KFRE40). If all patients potentially had undergone successful AV access surgery at KFRE40, 75% of patients would ever start dialysis with an AV access; in two years 13% would die and 31% be alive with an unused access. For AV access surgery at eGFR15, 88% would ever initiate KRT with an AV access; in two years 17% would die, and 40% live with an AV access never used.

Conclusion

Using KFRE >40% as decision threshold would increase the proportion of patients starting with a working AV access at the cost of more patients experiencing unnecessary surgery. The KFRE threshold >40% could complement decision making for vascular access creation.

Development of KFRE in nephrology-referred patients, in the year before Hemodialysis initiation