Abstract: FR-PO510
A Feasibility Study Investigating the Role of Kidney Failure Risk Equation in Optimizing the Timing of Vascular Access Creation
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Atiquzzaman, Mohammad, The University of British Columbia, Vancouver, British Columbia, Canada
- Zhu, Bingyue, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
- Er, Lee, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
- Romann, Alexandra, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
- Djurdjev, Ognjenka, BC Provincial Renal Agency, Vancouver, British Columbia, Canada
- Levin, Adeera, The University of British Columbia, Vancouver, British Columbia, Canada
Background
KFRE 2-year risk threshold of >40% along with existing eGFR based referral for vascular access (VA) creation may improve VA resource utilization. We investigated if KFRE score can play a role in optimizing the timing of VA creation.
Methods
We analyzed a cohort of 2,581 patients with CKD who had an eGFR of <20 ml/min/1.73m2 and chose hemodialysis (HD) as their preferred mode of dialysis. We created the cohort using data from PROMIS, a population-level registry database for patients with CKD in BC, Canada. Modality selection date was index date. In step 1, we explored the association between KRFE-2 threshold and timing of HD initiation among patients who reached kidney failure and initiated HD within 24 months from the index date in two ways: First, we categorized the patients based on time to HD initiation into 0-3, 3-6, 6-9, 9-12 and 12-24 months, and investigated the corresponding distribution of KFRE-2 scores at index. Second, we categorized the patients based on index KFRE-2 score into <40%, 40-<50%, 50-<60%, 60-<70%, 70-<80% and >80% and investigated the distribution of time to HD initiation. In step 2, we explored the positive predictive value (PPV) of initiating HD within 6 and 24 months using the aforementioned KFRE-2 thresholds among the entire cohort.
Results
Study cohort included 2581 patients, median age 71 years, and 40% female. Of the 1,562 patients who initiated HD within 2 years, a total of 733 (47%) patients initiated HD within 6 months and the median index KFRE-2 was ≥69% (Table 1A). On the other hand, 207 (13%) patients had an index KFRE-2 of 60 - <70% and the median time to initiate HD was 6.4 months (Table 1B). PPV gradually increased with increasing KFRE-2 threshold for both HD initiation within 6 and 24 months (Fig 1).
Conclusion
KFRE-2 score has the potential to guide the timing of VA creation. Future research using sophisticated methodology is required to identify an optimal KFRE-2 score for fistula/graft creation.