KFRE score superior to eGFR alone in predicting 2-year ESKD risk

The Kidney Failure Risk Equation (KFRE) score is better than estimated glomerular filtration rate (eGFR) alone in predicting the 2-year risk for end-stage kidney disease (ESKD), regardless of race adjustment, suggests a study. The creatinine equation with age and sex may improve calibration in Black patients.

“A KFRE score greater than 20 percent showed high specificity and sensitivity for predicting 2-year risk for ESKD,” the investigators said.

This observational, prospective cohort study was conducted at seven clinical centres in the US to compare the ESKD prediction performance of different eGFR equations among 3,873 patients with chronic kidney disease (CKD) from the Chronic Renal Insufficiency Cohort study.

ESKD was defined as initiation of dialysis or transplantation. The investigators calculated eGFR using five CKD Epidemiology Collaboration equations based on serum creatinine and/or cystatin C, with or without race adjustment. They also calculated the predicted 2-year risk ESKD using the four-variable KFRE.

The prediction performance of eGFR equations and the KFRE score was assessed using discrimination and calibration analyses.

Some 856 participants developed ESKD during a maximum of 16 years of follow-up. The KFRE score was superior to eGFR alone for predicting 2-year incidence of ESKD (area under the curve ranges, 0.945‒0.954 vs 0.900‒0.927) across all eGFR equations.

KFRE scores using different eGFR equations showed a similar prediction performance, but the creatinine equation without race adjustment improved calibration among Blacks.

Among all participants, a KFRE score >20 percent had a similar specificity for predicting 2-year ESKD risk (ranges, 0.94‒0.97 vs 0.95‒0.98) but higher sensitivity (ranges, 0.68‒0.78 vs 0.42‒0.66) relative to an eGFR <20 mL/min/1.73 m².

The analysis was limited by data sourced solely from the US.