Do High Kidney Failure Risk Equation (KFRE) Scores Predict Poor Chronic Kidney Disease Metric Compliance or Vice Versa?

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Do High Kidney Failure Risk Equation (KFRE) Scores Predict Poor Chronic Kidney Disease Metric Compliance or Vice Versa?

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Co-author 1

Hooi Chin Beh hcbeh@ummc.edu.my Universiti Malaya Department of Primary Care Medicine Kuala Lumpur Malaysia *

Co-author 2

Ying Guat Ooi yingguat@ummc.edu.my Universiti Malaya Department of Medicine Kuala Lumpur Malaysia -

Co-author 3

Sthaneswar Pavai pavai@ummc.edu.my Universiti Malaya Department of Pathology Kuala Lumpur Malaysia -

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Soo Kun Lim limsk@ummc.edu.my Universiti Malaya Department of Medicine Kuala Lumpur Malaysia -

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Introduction

Kidney failure risk equation (KFRE) is a prediction model to predict 2-year and 5-year risk of progression to end stage kidney disease (ESKD) among chronic kidney disease (CKD) stage 3 and 4 patients. This study investigates whether KFRE high-risk group is associated with lower degree of adherence to CKD management metrics.

Methods

This is a retrospective study recruiting people with CKD stage 3 to 4 who attended renal and primary care clinic follow-up in University Malaya Medical Centre and had at least one urinary albumin-creatinine ratio(uACR) measured in 2022 to calculate 4-variable KFRE for 2-year and 5-year risk of ESKD. When only urinary protein-creatinine ratio(uPCR) is available, albuminuria is estimated by using uPCR to uACR calculator. Optimal CKD management metrics include optimal prescription of renin-angiotensin system inhibitors, blood pressure control (< 130/80 mmHg), and HbA1c control (< 7%). Association between KFRE risk groups and degree of adherence to CKD management metrics was analysed using SPSS.

Results

A total of 5256 patients were included. Median age group 72 (IQR 14). 4278 (81.4%) patients had CKD stage 3 which 5.4% were in high risk, 17.1% were in moderate-risk and 77.5% were in low-risk KFRE groups. Among patients with CKD stage 3, there was significance association of RAS blocker (p=0.004) and SGLT2i prescription (<0.001) and Hb1Ac control (p<0.001) but not for BP control (p<0.058) with KFRE categories.

Out of 978 (18.6%) patients who had CKD stage 4, 25.6% had high-risk, 28.7% had moderate-risk and 45.7% had low-risk KFRE groups. Among patients with CKD stage 4, there was significance association of BP control (p<0.002) with KFRE groups while no significance between RAS blocker (p=0.729) and SGLT2i prescription (0.224) and Hb1Ac control (p=0.547) with KFRE categories.

Conclusion

Overall, these findings suggest that pharmacologic and metabolic factors are more influential in modulating kidney failure risk in CKD stage 3, whereas effective blood pressure control becomes the key determinant in advanced (stage 4) CKD.

Kewords