Abstract: FR-PO961
Implementation of the Kidney Failure Risk Equation in a US Nephrology Clinic
Session Information
- CKD Interventions: Trials and Quality Improvement
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Patel, Dipal, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Churilla, Bryce Matthew, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Thiessen Philbrook, Heather, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Sang, Yingying, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
- Parikh, Chirag R., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background
The kidney failure risk equation (KFRE) estimates a person’s risk of kidney failure. We explored implementation of the KFRE in a U.S. nephrology clinic.
Methods
We integrated KFRE scores into the electronic health record (EHR) for patients with CKD being seen in Johns Hopkins nephrology clinics. We quantified documentation of KFRE scores in clinic notes and conducted surveys and focus groups of nephrology providers to assess provider perspectives on its use. Focus groups were audio-recorded and transcripts were coded using thematic analysis.
Results
Documentation of KFRE scores increased over time, reaching 25% of all eligible outpatient nephrology clinic notes after 11 months. Of 44 nephrology providers, 3 documented KFRE scores in > 75% of notes, whereas 25 documented scores in < 10% of notes. Survey respondents (n=25) reported variability in use of KFRE scores for decisions such as maintaining nephrology care, referring for transplant evaluation, or providing dialysis modality education. Provider perspectivess, assessed by qualitative analysis of focus groups transcripts, included three common themes: 1) KFRE scores may be most impactful in care of specific subsets of people with CKD; 2) there is uncertainty surrounding KFRE risk-based thresholds to guide clinical care, and 3) education of patients, nephrology providers, and non-nephrology providers on appropriate interpretations of KFRE scores may help maximize their utility. Based upon these findings, we propose key components of KFRE implementation as a roadmap for future efforts to increase its use in clinical care (Figure).
Conclusion
KFRE score documentation increased over time, with variability in adoption by providers. Further knowledge surrounding utilization of the KFRE in clinical decisions may enhance its implementation.
Roadmap for KFRE implementation.
Funding
- NIDDK Support