Dr Regina Hong1, Dr Daniel Hirsch1, Miss Katherine Li2, Mrs Saiyini Pirabhahar1, Mrs Kylie Turner1, Dr Jeffrey Ha3,4, Prof Ivor Katz1,2
1Department of Renal Medicine, St George Hospital, Kogarah, Australia, 2Faculty of Medicine & Health, University of New South Wales, Randwick, Australia, 3Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 4Renal & Metabolic Division, The George Institute for Global Health, , Sydney, Australia
Biography:
Bio to come
Aim:
To compare the utility of the KFRE with traditional eGFR thresholds for vascular access planning in an Australian cohort.
Background:
The Kidney Failure Risk Equation (KFRE) is a validated tool assessing risk of progression to kidney failure requiring renal replacement therapy. A 2-year KFRE risk threshold over 40% is purported to support clinical decision-making for vascular access planning.
Methods:
This was a single-centre observational cohort study. We retrospectively reviewed 580 adult patients referred to a kidney pre-dialysis education clinic (KDEC) between 2016 and 2021. 211 patients who underwent dialysis access formation were included in analysis. We described their trajectory including eGFR and 2-year KFRE at important decision thresholds (KDEC referral, access formation, dialysis initiation) and rates of emergency access formation.
Results:
Of 211 patients who underwent access formation, 204 proceeded to dialysis initiation during the follow-up period. Median 2-year KFRE score was 45.7% at 12 months prior to dialysis, 52.3% at KDEC referral, and 72.8% at access formation. In comparison, median eGFR was 15ml/min/1.73m2, 14ml/min/1.73m2 and 8ml/min/1.73m2 respectively. 31.5% of haemodialysis patients underwent emergency access creation. They had lower eGFR at referral (11 vs 15ml/min/1.73m2), higher KFRE at referral (62% vs 50%) and access formation (87% vs 62%), and more preceding hospitalisations (95.4% vs 38.5%).
Conclusion:
The KFRE is a useful tool to support clinical decision-making for vascular access planning and is better than eGFR alone. A KFRE score of 46% predicted need for dialysis in 12 months. A KFRE threshold of 40-50% may guide timely referral to KDEC and timely access planning.