Abstract: PO0449
The Kidney Failure Risk Equation: Testing Previous eGFR Slopes, Clinical Variables, and Novel Populations
Session Information
- CKD Epidemiology, Biomarkers, Predictors
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Grams, Morgan, CKD Prognosis Consortium, Baltimore, Maryland, United States
- Brunskill, Nigel J., CKD Prognosis Consortium, Baltimore, Maryland, United States
- Wang, Angela Yee Moon, CKD Prognosis Consortium, Baltimore, Maryland, United States
- Tangri, Navdeep, CKD Prognosis Consortium, Baltimore, Maryland, United States
Group or Team Name
- CKD Prognosis Consortium
Background
The 4-variable kidney failure risk equation (KFRE) is a well-validated tool that accurately predicts the 2- and 5-year risk of kidney failure in patients with eGFR <60 ml/min/1.73 m2 using baseline eGFR, ACR, age, and sex. The aim of this study was two-fold: to assess whether KFRE can be improved using previous eGFR slope or other variables; and to evaluate whether the KFRE can be used in patients with eGFR ≥60 ml/min/1.73 m2.
Methods
We used 36 cohorts in development and 17 cohorts in validation to accomplish these aims; all cohorts participate in the CKD-Prognosis Consortium and had data on the four variables, previous 2-year eGFR slope, and at least 25 ESKD events.
Results
There were 205,004 participants with eGFR <60 ml/min/1.73 m2 (12,794 ESKD events) and 441,915 participants with eGFR ≥60 ml/min/1.73 m2 (1,220 ESKD events). In the eGFR <60 group, previous 2-year eGFR loss >3 ml/min/1.73 m2/year was associated with ESKD (meta-analyzed HR 1.36, 95% CI: 1.19-1.56) with a small improvement over the 4-variable model (baseline c-statistic in validation cohorts, 0.87-0.95; meta-analyzed difference in c-statistic in validation cohorts when adding slope, 0.001, 95% CI: 0.000-0.002). Using previous 5-year slope resulted in slightly better c-statistic compared to the model using 2-year slope (meta-analyzed difference in c-statistic in validation cohorts, 0.003, 95% CI: 0.001-0.005). Other approaches, such as using 1-year average eGFR or 1-year average ACR as inputs in the 4-variable KFRE, or incorporating black race, heart failure, or atrial fibrillation, did not result in meaningful improvements. The KFRE had poor discrimination and calibration in the eGFR ≥60 ml/min/1.73 m2 population. In a model that instead predicted 40% decline in eGFR and included age, sex, ACR, diabetes, hypertension, heart failure, and coronary heart disease, previous eGFR loss > 3 ml/min/1.73 m2/year over 2- and 5-years were associated with greater risk (HR, 1.43, 95%CI: 1.19-1.70; 1.84, 95%CI: 1.40-2.42).
Conclusion
In summary, the KFRE was improved only slightly by the inclusion of previous eGFR slope. For populations with eGFR >60, a more relevant and predictable outcome may be percent eGFR decline.
Funding
- NIDDK Support