Kidney Week

Abstract: TH-PO0989

Integrating eGFR and Kidney Replacement Therapy Criteria Within the Definition of Kidney Failure: A Population-Based Cohort Study

Session Information

• Diversity and Equity in Kidney Health
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Liu, Ping, University of Calgary, Calgary, Alberta, Canada

Ping Liu, PhD

• Sawhney, Simon, University of Aberdeen, Aberdeen, Scotland, United Kingdom

Simon Sawhney, MBChB, PhD

• Lam, Ngan, University of Calgary, Calgary, Alberta, Canada

Ngan Lam, MD, MSc

• Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada

Robert R. Quinn, MD, PhD

• Christiansen, Christian Fynbo, Aarhus Universitetshospital, Aarhus, Central Denmark Region , Denmark

Christian Fynbo Christiansen, MD, PhD

• Hundemer, Gregory L., University of Ottawa, Ottawa, Ontario, Canada

Gregory L. Hundemer, MD, MPH

• Akbari, Ayub, University of Ottawa, Ottawa, Ontario, Canada

Ayub Akbari, MD, MS, MSc, FASN

• Elliott, Meghan J., University of Calgary, Calgary, Alberta, Canada

Meghan J. Elliott, MD

• Harrison, Tyrone, University of Calgary, Calgary, Alberta, Canada

Tyrone Harrison, MD, PhD

• Ronksley, Paul E., University of Calgary, Calgary, Alberta, Canada

Paul E. Ronksley, PhD

• Tam-Tham, Helen, University of Calgary, Calgary, Alberta, Canada

Helen Tam-Tham

• Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada

Karthik K. Tennankore, MD, MS

• James, Matthew T., University of Calgary, Calgary, Alberta, Canada

Matthew T. James, MD, PhD

• Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada

Pietro Ravani, MD, PhD

Background

Guidelines define kidney failure based on initiation of maintenance kidney replacement therapy (KRT) or eGFR below 15 mL/min/1.73 m² for over 90 days, but most kidney failure registries track the incidence and outcomes of people who receive KRT only. The population burden of kidney failure and outcomes of patients identified by eGFR criteria remain under-studied.

Methods

Using population-based datasets from Alberta, Canada, we studied adults (≥18 years) who initiated maintenance KRT or had incident kidney failure defined by KRT or eGFR criteria between April 2008 and March 2019. People who met eGFR criteria for kidney failure were followed from cohort entry until death, initiation of KRT, or censoring (outmigration or March 31, 2021), to estimate the 5-year risks of KRT initiation and death without receiving KRT, and the rates of acute care utilization during follow-up.

Results

The annual incidence was 212 per million population for KRT versus 293 for kidney failure, with larger incidence differences between KRT and kidney failure in older age and females. Among the 9691 incident kidney failure cases, 6216 (64.1%) were first identified by eGFR criteria. Within 5 years of meeting eGFR criteria, 34.0% died without KRT. Females were less likely to receive KRT, more likely to die without receiving KRT, and had higher acute care use.

Conclusion

KRT registries may capture one-third of incident kidney failure cases, inaccurately record the timing of disease onset, and under-represent older adults and females who have worse outcomes. Incorporating eGFR measurements to expand kidney failure data collection initiatives could improve early disease identification, equity of healthcare planning, and outcome reporting for all affected individuals.

Funding

• Government Support – Non-U.S.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20259a1wywzj