The kidney failure risk equation predicts kidney failure: Validation in an Australian cohort

Abstract

Aims: Predicting progression to kidney failure for patients with chronic kidney disease is essential for patient and clinicians' management decisions, patient prognosis, and service planning. The Tangri et al Kidney Failure Risk Equation (KFRE) was developed to predict the outcome of kidney failure. The KFRE has not been independently validated in an Australian Cohort. Methods: Using data linkage of the Tasmanian Chronic Kidney Disease study (CKD. TASlink) and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), we externally validated the KFRE. We validated the 4, 6, and 8-variable KFRE at both 2 and 5 years. We assessed model fit (goodness of fit), discrimination (Harell's C statistic), and calibration (observed vs predicted survival). Results: There were 18 170 in the cohort with 12 861 participants with 2 years and 8182 with 5 years outcomes. Of these 2607 people died and 285 progressed to kidney replacement therapy. The KFRE has excellent discrimination with C statistics of 0.96-0.98 at 2 years and 0.95-0.96 at 5 years. The calibration was adequate with well-performing Brier scores (0.004-0.01 at 2 years, 0.01-0.03 at 5 years) however the calibration curves, whilst adequate, indicate that predicted outcomes are systematically worse than observed. Conclusion: This external validation study demonstrates the KFRE performs well in an Australian population and can be used by clinicians and service planners for individualised risk prediction.

Clinical Decision Support Tools in the Electronic Medical Record

“…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.…”