Kidney Week

Abstract: TH-PO257

Planning Vascular Access Creation: The Promising Role of the Kidney Failure Risk Equation

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

• Marques da Silva, Bernardo, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Bernardo Marques da Silva,

• Silva, Onassis, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Onassis Silva,

• Dores, Mariana, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Lisboa, Portugal

Mariana Dores,

• Outerelo, Cristina, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Cristina Outerelo,

• Fortes, Maria Alice gonçalves, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Maria Alice gonçalves Fortes,

• Lopes, Jose António, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Jose António Lopes,

• Gameiro, Joana, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal

Joana Gameiro,

Background

Planning the vascular access (VA) is essential in pre-dialysis patients although optimal timing for VA referral and placement is still debatable. Current guidelines suggest referral for VA placement with an eGFR15-20ml/min/1.73m². The kidney failure risk equation (KFRE) is an easily calculated equation to predict probability of KRT. The aim of this study was to validate KFRE in patients referred to VA assessment.

Methods

We conducted a retrospective analysis of all adult patients with CKD who were referred to the multidisciplinary VA consult, for the first VA placement, at C.H.U. Lisboa Norte between January 2018 and December 2019. The 4-variable KFRE was calculated. Requirement of KRT, mortality and vascular access placement were assessed in a 2-year follow-up. We used the Cox logistic regression to predict KRT requirement and calculated the ROC curve.

Results

256 patients were included and 64.5% were male. At the time of VA consult, mean age was 70.4±12.9 years, eGFR was 16.09±10.43ml/min/1.73m², albuminuria was 1339.4±208.1mg/24h and the mean calculated risk score was 30.44±24.80%. 159 patients required KRT (62.1%) and 72 (28.3%) died in the 2-year follow-up. VA was created in 214 (83.6%) patients, though only 50.9% patients had a functional VA for hemodialysis. The KFRE accurately predicted KRT requirement within 2-years [38.3±23.8 vs 17.6±20.9%, p<0.001; HR 1.05 95% CI (1.06-1.12), p<0.001], with an auROC of 0.788, [p<0.001, 95% CI (0.733-0.837)]. The optimal KFRE cut-off was >20%, with a HR of 9.2 [95% CI (5.06-16.60), p<0.001]. 135 (52.7%) patients had KFRE≥20% at the time for VA referral and mean time from VA consult to KRT initiation was significantly lower in these patients (10.98±9.64 vs 16.50±11.14 months, p=0.002). On a sub-analysis of patients with an eGFR<20mL/min/1.73m², a KFRE≥20% was also a significant predictor of 2-year requirement of KRT, with an HR of 6.61 [CI 95% (3.49-12.52), p<0.001].

Conclusion

KFRE accurately predicted 2-year KRT requirement in this cohort of patients. We have successfully demonstrated that a KFRE ≥20% can be used in addition to eGFR when referring patients for VA planning and help to establish higher priority patients for VA placement. The authors suggest referral for VA creation when eGFR<20mL/min/1.73m² and KFRE≥20%.