Validation of the kidney failure risk equation in a Portuguese cohort

Silva, Bernardo Marques da; Charreu, José; Duarte, Inês; Outerelo, Cristina; Gameiro, Joana

doi:10.1016/j.nefroe.2022.03.007

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…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.…”

Section: History Of Emrsmentioning

confidence: 99%

Clinical Decision Support Tools in the Electronic Medical Record

Alexiuk,

Elgubtan,

Tangri

2024

Kidney International Reports

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Section: History Of Emrsmentioning

confidence: 99%

Clinical Decision Support Tools in the Electronic Medical Record

Alexiuk,

Elgubtan,

Tangri

2024

Kidney International Reports

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External validation of the KFRE and Grams prediction models for kidney failure and death in a Spanish cohort of patients with advanced chronic kidney disease

Gallego-Valcarce,

Shabaka,

Tato-Ribera

et al. 2023

J Nephrol

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Using the kidney failure risk equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

Maher,

Teece,

Major

et al. 2023

Diagn Progn Res

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Background The kidney failure risk equation (KFRE) predicts the 2- and 5-year risk of needing kidney replacement therapy (KRT) using four risk factors — age, sex, urine albumin-to-creatinine ratio (ACR) and creatinine-based estimated glomerular filtration rate (eGFR). Although the KFRE has been recalibrated in a UK cohort, this did not consider minority ethnic groups. Further validation of the KFRE in different ethnicities is a research priority. The KFRE also does not consider the competing risk of death, which may lead to overestimation of KRT risk. This study externally validates the KFRE for patients of South Asian ethnicity and compares methods for accounting for ethnicity and the competing event of death. Methods Data were gathered from an established UK cohort containing 35,539 individuals diagnosed with chronic kidney disease. The KFRE was externally validated and updated in several ways taking into account ethnicity, using recognised methods for time-to-event data, including the competing risk of death. A clinical impact assessment compared the updated models through consideration of referrals made to secondary care. Results The external validation showed the risk of KRT differed by ethnicity. Model validation performance improved when incorporating ethnicity and its interactions with ACR and eGFR as additional risk factors. Furthermore, accounting for the competing risk of death improved prediction. Using criteria of 5 years ≥ 5% predicted KRT risk, the competing risks model resulted in an extra 3 unnecessary referrals (0.59% increase) but identified an extra 1 KRT case (1.92% decrease) compared to the previous best model. Hybrid criteria of predicted risk using the competing risks model and ACR ≥ 70 mg/mmol should be used in referrals to secondary care. Conclusions The accuracy of KFRE prediction improves when updated to consider South Asian ethnicity and to account for the competing risk of death. This may reduce unnecessary referrals whilst identifying risks of KRT and could further individualise the KFRE and improve its clinical utility. Further research should consider other ethnicities.

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Validation of the kidney failure risk equation in a Portuguese cohort

Cited by 3 publications

References 20 publications

Clinical Decision Support Tools in the Electronic Medical Record

Clinical Decision Support Tools in the Electronic Medical Record

External validation of the KFRE and Grams prediction models for kidney failure and death in a Spanish cohort of patients with advanced chronic kidney disease

Using the kidney failure risk equation to predict end-stage kidney disease in CKD patients of South Asian ethnicity: an external validation study

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