Utility of 2-year Kidney Failure Risk Equation for advanced chronic kidney disease: analysis from the STOP ACEi Trial

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https://storage.unitedwebnetwork.com/files/1099/4364eb03adf00c8b922831f7c4fad452.pdf

Abstract Title

First Name *

Sunil

Last Name *

Bhandari

Co-author 1

Samir Mehta s.mehta.1@bham.ac.uk University of Birmingham Birmingham Clinical Trials Unit Birmingham

Co-author 2

Natalie Ives n.j.ives@bham.ac.uk University of Birmingham Birmingham Clinical Trials Unit Birmingham

Co-author 3

Paul Cockwell p.cockwell@uhb.nhs.net Queen Elizabeth Hospital Nephrology Birmingham

Co-author 4

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

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Introduction

Background and objectives

The rate of progression of chronic kidney disease to kidney failure (a requirement for dialysis or transplantation) is variable and prognostic information helps patients and clinicians plan care. The kidney failure risk equation (KFRE) is used to calculate risk of kidney failure in patients with CKD however the utility of KFRE in patients with advanced CKD is uncertain.

Design, setting, participants, & measurements

Kidney failure risk equation calculation and discrimination for 2-year risk of progression to kidney failure in patients recruited into the STOP-ACEi randomised controlled trial.

Methods

The KFRE 4 and 8 variable equations calibrated to a non-North American population were used to calculate the 2-year risk and compared to the observed outcomes. Patients were then categorised into 2-year risk groups of <20%, 20 to <40% and ≥40%. We examined correlations between KFRE estimations and observed events accounting for the competing risk of death. Harrell’s C-statistic and calibration curve were calculated to assess the model discrimination and calibration.

Results

411 patients were included of which 68% were male. Median age, eGFR ACR, calcium, phosphate, bicarbonate and albumin were 63 years, 18 ml/min per 1.73 m2, 680 mg/g, 9 mg/dL, 4 mg/dL, 22 mmol/L and 4 g/dL respectively. Median [IQR] calculated 2-year risk scores based on the 4 and 8 variable equations were 24% [13 to 44%] and 21% [11 to 44%] respectively. Overall, 200 participants (49%) reached ESKD or KRT at 2 years, and 17 (4%) died before reaching ESKD or KRT within 2 years. Harrell's C statistic for the 4 and 8 variable equations were 0.71 (95% CI 0.68 to 0.74) and 0.71 (95% CI 0.67 to 0.74) respectively, which suggest that the KFRE equations had a good prediction of those that reached ESKD/KRT at 2 years (Figure 1). There was clear separation of discrimination such that a 2-year KFRE of >40% (6.94 (95% CI 4.87 to 9.90) for the 4 variable) provides a threshold for interventions, establishing dialysis modality and listing for kidney transplantation. Discontinuation of ACEi/ARB did not impact the prediction of progression at 2 years.

Figure 1 – Kaplan-Meier curve for 4-variable Kidney Failure Risk Equation (KFRE) for risk based on <20%; ≥20 and <40%; ≥40%.

Conclusions

The KFRE performs well in patients with advanced CKD and utilizing broad risk thresholds may inform patient information and service configuration.

Not previously presented at another meeting.

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