Implementation of the Kidney Failure Risk Equation in a United States Nephrology Clinic

Clinical Decision Support Tools in the Electronic Medical Record

“… 45 , 46 , 47 Because of the simplicity of the KFRE and accessibility of the variables included in the KFRE, it has previously been implemented into EMR systems to support both clinical practice and research on CDS tool integration. 38 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 Via its integration with EMR systems, KFRE can be automatically calculated, improving the identification of patients at risk of developing kidney failure and improving provider workflow. 45 , 46 , 47 , 49 , 52 , 53 , 55 , 57 , 60 , 61 Others 45 , 47 have suggested that incorporating automatic prompts into a KFRE CDS tool to encourage providers to order urinary albumin-to-creatinine ratio testing, which is not routinely collected, would improve the accuracy of KFRE and downstream patient outcomes.…”

“…Currently, the KFRE is the most widely used prediction model in nephrology practices and in clinical research. 46 , 50 , 53 , 55 , 56 , 57 , 58 , 59 , 62 , 63 , 64 , 65 , 66 However, most patients with early-stage CKD and at risk of developing end-stage kidney disease receive care and disease management through their primary care provider. 38 , 42 , 43 , 46 , 50 , 53 , 55 , 56 , 59 , 67 , 68 Unfortunately, these primary-care-managed patients with CKD often receive suboptimal treatment because of their providers’ limited understanding of CKD, its treatment options, and general poor clinical guideline adherence.…”

“… 46 , 50 , 53 , 55 , 56 , 57 , 58 , 59 , 62 , 63 , 64 , 65 , 66 However, most patients with early-stage CKD and at risk of developing end-stage kidney disease receive care and disease management through their primary care provider. 38 , 42 , 43 , 46 , 50 , 53 , 55 , 56 , 59 , 67 , 68 Unfortunately, these primary-care-managed patients with CKD often receive suboptimal treatment because of their providers’ limited understanding of CKD, its treatment options, and general poor clinical guideline adherence. 10 , 38 , 42 , 50 , 51 , 68 , 69 The use of KFRE is limited among primary care providers, resulting in patients rarely receiving referrals to nephrology, or being referred much later than is ideal for disease management.…”

“… 10 , 38 , 42 , 50 , 51 , 68 , 69 The use of KFRE is limited among primary care providers, resulting in patients rarely receiving referrals to nephrology, or being referred much later than is ideal for disease management. 53 , 58 , 70 , 71 , 72 Like many other CDS tools, there is enormous potential to improve patient outcomes and provider workflows through KFRE integration in primary care settings, as previous research involving this tool has shown promising results. 56 …”

“… 53 Their study participants of faculty and fellow nephrologists highlighted the benefits of automatic calculation to improve their workflow, assist in kidney replacement therapy planning, and summarized possible health outcomes for their patients and nonnephrology care providers. 53 In addition to displaying both 2-year and 5-year risk of kidney failure, the automatic calculation of KFRE by the EMR system additionally allows for a consistent measure of kidney failure risk over time, and displays patient medications and other kidney events, including renal biopsies and emergency department visits, as displayed in Figure 1 . 53

Figure 1 Sample dashboard display of the Kidney Failure Risk Equation integrated into an electronic medical record system.

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