Abstract: SA-PO1208
Optimizing Kidney Replacement Therapy Preparation Using Kidney Failure Risk Equation (KFRE) and eGFR Fall Rate: A Single-Centre, Risk-Based Approach for Effective Care Planning
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Fakhar, Muhammad Bilal, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Mehr Ghulam, Muhammad Farooq, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Nwizu, Chioma C., East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Ratcliffe, Laura Ema Kvetuse, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Vilar, Enric, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Sridharan, Sivakumar, East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
- Chandna, Shahid M., East and North Hertfordshire NHS Trust, Stevenage, England, United Kingdom
Group or Team Name
- East & North Hertfordshire Teaching Hospital, NHS Foundation Trust.
Background
The Kidney Failure Risk Equation (KFRE) is a validated prognostic tool that estimates the 2- and 5-year risk of progression to kidney failure in patients with chronic kidney disease (CKD). Although it has strong predictive performance, the use of KFRE in clinical practice for guiding dialysis preparation, such as determining the timing of access placement, remains limited. A deficiency, in this setting, is the absence of eGFR fall rate in the preceding year.
Methods
We conducted a single-centre retrospective observational study of patients with advanced CKD in all patients having 2 consecutive eGFR of <20 ml/min/1.73m2 between Jan 2007 and April 2023. Those with AKI with clear reversibility were excluded. KFRE 2-year risk scores were calculated using the 4-variable model, recalibrated for the UK population. Patients were stratified into three risk categories: KFRE; eGFR fall rate in preceding year; and primary renal diagnosis.
Results
Of the 1913 eligible patients 1586 (82.9%) were in the pre-RRT group and 327 (17.1%) were in the conservative management (CM) group. Of the pre-RRT group, 1000 (63.1%) started RRT. Of the CM group 102 (31.2%) reached the endpoint of eGFR 8, and 179 (54.7%) died before reaching the endpoint. Using binary logistic regression, KFRE, rate of eGFR fall and age were strong predictors of ESRF in 2 years. uACR was a predictor if KFRE is not used. Interstitial nephritis and obstructive uropathy were predictors of slow decline in a univariate but not multivariate models.
Conclusion
KFRE is an effective tool for stratifying risk and informing dialysis preparation, but can be improved by the addition of rate of eGFR fall. Whilst CM is an important treatment choice, at least some patients were disadvantaged by having these discussions when there was low likelihood of progression to ESRF.