Similar results in measuring time to kidney failure for kidney failure risk equation, eGFR
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Key takeaways:
- In patients with advanced CKD, the kidney failure risk equation and eGFR showed comparable estimates.
- Estimated time to kidney failure varied in patients with less severe kidney disease.
Measuring time to kidney failure in advanced chronic kidney disease can inform clinical decisions and patient counseling, regardless of estimates based on eGFR or the kidney failure risk equation, according to recently published data.
“A major challenge in the care of patients with advanced chronic kidney disease is the optimal timing of clinical decisions based on their risk [for] future kidney failure,” Chi D. Chu, MD, MAS, in the division of nephology at Zuckerberg San Francisco General Hospital, and colleagues, wrote. The multicenter study “provides an additional way of expressing prognosis that may be more intuitive than cumulative incidence and could help guide time-dependent clinical decisions.”
In the retrospective cohort study, researchers used data from the CKD Outcomes and Practice Patterns Study U.S. cohort to analyze 1,641 patients with CKD who were not receiving maintenance dialysis and did not have prior kidney transplantation.
Researchers built accelerated failure time models to estimate the association between eGFR and kidney failure risk equation (KFRE)-predicted risk and time to kidney failure. The KFRE estimates 2- and 5-year risk of kidney failure with CKD.
Estimated time to kidney failure varied in patients with an eGFR of 20 mL/min/1.73m2, according to study results. It was shorter for younger, male and Black vs. non-Black patients, and for patients with diabetes, higher albuminuria and higher blood pressure.
“In less advanced CKD, the KFRE may provide more consistent and equitable estimates of time to kidney failure across different patient characteristics, but time estimates are widely imprecise for both eGFR and KFRE,” according to the research.
Patients with an eGFR less than 15 mL/min/1.73 m2 or KFRE risk greater than 40%, KFRE risk and eGFR showed similar relationships with time to kidney failure.
“Our results demonstrate that estimating time to kidney failure in advanced CKD can inform clinical decisions and patient counseling on prognosis, regardless of whether estimates are based on eGFR or the KFRE,” Chu and colleagues wrote.
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