Kidney Week

Abstract: SA-PO752

Validation of the Kidney Failure Risk Equation in Primary Care Clinics in Southeast Asia

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Wang, Yeli, Duke-NUS Medical School, Singapore, Singapore

Yeli Wang,

• Nguyen, Francis, SingHealth, Singapore, Singapore

Francis Nguyen,

• Allen, John C., Duke-NUS Medical School, Singapore, Singapore

John C. Allen,

• Tan, Ngiap chuan, SingHealth Polyclinics, Singapore, Singapore

Ngiap chuan Tan,

• Jafar, Tazeen H., Duke-NUS Medical School, Singapore, Singapore

Tazeen H. Jafar,

Background

Patients with chronic kidney disease (CKD) are at high risk of progression to end stage kidney disease (ESKD). The Kidney Failure Risk Equation (KRFE) was developed to accurately predict the progression of CKD to kidney failure. However, it has not been validated in primary care clinic settings in Asia. The objective of this study was to validate the predictive utility of KFRE for ESRD risk, and compare it with that of eGFR alone in polyclinics in Singapore.

Methods

Electronic health records were extracted from 9 government clinics on 117,528 patients aged 40 years or older visiting clinics during 1^st Jan 2010 to 31^st Dec 2012 with at least one measurement of serum creatinine or proteinuria. All patients with CKD-EPI estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m² and proteinuria had KFRE evaluated using the 4-variable equation (age, sex, eGFR, ACR). ESRD was determined by linkage with Singapore Renal Registry. Area under the operating characteristics curves (AUC) was used to calculate the predictive utility for 5-year risk of ESRD with KFRE versus eGFR alone.

Results

A total of 17271 participants had eGFR <60 ml/min/1.73m² of whom 49% were men, 80% were Chinese, 12% were Indian and 4% were Malays. After a mean follow-up of 5 years, a total of 491 (2.8%) patients developed ESRD. The AUC (95% confidence interval) for KFRE and eGFR alone was 0.93 (0.92-0.94) and 0.89 (0.88-0.91), respectively.

Conclusion

The KFRE showed excellent predictive utility, which was better than eGFR alone for ESRD risk in this multi-ethnic population. We provided several thresholds below for the clinical decision making and implementation in primary care clinics in Singapore and possibly other Asian countries.

Funding

• Government Support - Non-U.S.