Kidney Week

Abstract: FR-PO1023

Does Clinical Utility of the Kidney Failure Risk Equation in Routine Clinical Practice Vary by Socioeconomic Status?

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Walker, Heather, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Glasgow, United Kingdom

Heather Walker, MBChB, MS, MSc

• Khan, Shabana, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Glasgow, United Kingdom

Shabana Khan

• Jani, Bhautesh Dinesh, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Glasgow, United Kingdom

Bhautesh Dinesh Jani, MBChB, PhD

• Gallacher, Katie I., University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, Glasgow, United Kingdom

Katie I. Gallacher, MBChB, PhD

• Mark, Patrick Barry, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Patrick Barry Mark, MBChB, PhD

• Sullivan, Michael K., University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom

Michael K. Sullivan, MBChB, MS

Background

Risk prediction models such as the kidney failure risk equation (KFRE) have been recommended to identify patients at heightened risk of kidney failure requiring treatment (KFRT). Incorporating KFRE into clinical practice may be limited by rates of albuminuria testing. We used routine healthcare data to ascertain albuminuria testing rates in CKD by sub-groups including socio-economic deprivation, age or sex.

Methods

We used routine healthcare data for all adults in NHS Greater Glasgow, UK (population approximately 1.5mill). Two cohorts and analyses were performed. Analysis 1 cohort: CKD G3-5 (eGFR<60mL/min/1.73m² for >90 days without KFRT). Analysis 2 cohort: as per cohort 1 with albuminuria values within 6 months of meeting CKD diagnostic criteria. Analysis 1 used logistic regression models to quantify associations between predictor variables and albuminuria testing. Analysis 2 assessed the predictive performance of KFRE.

Results

Cohort 1 included 10,874 adults. Albuminuria testing was missing in 55.5% of people. Individuals most likely to have albuminuria testing were those aged 40-50 years (adjusted odds ratio (aOR) 1.83 (95% confidence interval (CI) 1.15-2.91), p=0.01) and those living in the least socioeconomically deprived areas (aOR 1.11 (95% CI 1.00-1.23), p=0.01). Individuals least likely to have albuminuria testing were females (aOR 0.86 (95% CI 0.79-0.93), p<0.001), those with hypertension (aOR 0.69 (95% CI 0.63-0.77), p<0.001) and those without a diagnosis of diabetes (aOR 0.43 (95% CI 0.39-0.47), p<0.001).
Cohort 2 included 4,902 adults, median eGFR 51.5 ml/min/1.73m². The highest albuminuria and KFRE risk values were identified in males, those aged 40-50 years old, people with a diagnosis of diabetes and individuals living in the most socio-economically deprived areas. KFRE model performance at five years was good but with over prediction at higher KFRE predicted risk groups (AUC 0.82).

Conclusion

KFRE performed well in this large observational population-based study using routinely collected data. KFRE could only be calculated for less than half of adults with CKD due to low rates of albuminuria testing, particularly for females, those without diabetes and those living in the most deprived areas.

Funding

• Private Foundation Support