Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Medicine, New York University Grossman School of Medicine, New York, New York.
J Am Soc Nephrol. 2023 Mar 1;34(3):482-494. doi: 10.1681/ASN.0000000000000050. Epub 2023 Jan 26.
The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict 2- and 5-year risk of kidney failure in populations with eGFR <60 ml/min per 1.73 m 2 . However, the CKD-EPI 2021 creatinine equation for eGFR is now recommended for use but has not been fully tested in the context of KFRE. In 59 cohorts comprising 312,424 patients with CKD, the authors assessed the predictive performance and calibration associated with the use of the CKD-EPI 2021 equation and whether additional variables and accounting for the competing risk of death improves the KFRE's performance. The KFRE generally performed well using the CKD-EPI 2021 eGFR in populations with eGFR <45 ml/min per 1.73 m 2 and was not improved by adding the 2-year prior eGFR slope and cardiovascular comorbidities.
The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict kidney failure risk in people with GFR <60 ml/min per 1.73 m 2 .
Using 59 cohorts with 312,424 patients with CKD, we tested several modifications to the KFRE for their potential to improve the KFRE: using the CKD-EPI 2021 creatinine equation for eGFR, substituting 1-year average ACR for single-measure ACR and 1-year average eGFR in participants with high eGFR variability, and adding 2-year prior eGFR slope and cardiovascular comorbidities. We also assessed calibration of the KFRE in subgroups of eGFR and age before and after accounting for the competing risk of death.
The KFRE remained accurate and well calibrated overall using the CKD-EPI 2021 eGFR equation. The other modifications did not improve KFRE performance. In subgroups of eGFR 45-59 ml/min per 1.73 m 2 and in older adults using the 5-year time horizon, the KFRE demonstrated systematic underprediction and overprediction, respectively. We developed and tested a new model with a spline term in eGFR and incorporating the competing risk of mortality, resulting in more accurate calibration in those specific subgroups but not overall.
The original KFRE is generally accurate for eGFR <45 ml/min per 1.73 m 2 when using the CKD-EPI 2021 equation. Incorporating competing risk methodology and splines for eGFR may improve calibration in low-risk settings with longer time horizons. Including historical averages, eGFR slopes, or a competing risk design did not meaningfully alter KFRE performance in most circumstances.
肾衰竭风险方程（KFRE）使用年龄、性别、肾小球滤过率（GFR）和尿白蛋白与肌酐比值（ACR）来预测肾小球滤过率（GFR）<60ml/min/1.73m2的人群发生肾衰竭的风险。
利用包含 312424 例 CKD 患者的 59 个队列，我们测试了 KFRE 的多种改良方法，以评估其改善 KFRE 的潜力：使用 CKD-EPI 2021 肌酐方程估算 eGFR，用 1 年平均 ACR 替代单次测量的 ACR，用 1 年平均 eGFR 替代高 eGFR 变异性患者的单次测量 eGFR，以及添加 2 年前 eGFR 斜率和心血管合并症。我们还评估了校正死亡竞争风险前后 KFRE 在不同 eGFR 和年龄亚组中的校准情况。
总体而言，使用 CKD-EPI 2021 eGFR 方程，KFRE 仍然准确且校准良好。其他改良方法并未改善 KFRE 的性能。在 eGFR 为 45-59ml/min/1.73m2 的亚组和使用 5 年时间范围的老年患者中，KFRE 分别表现出系统的低估和高估。我们开发并测试了一个新的模型，其中包含 eGFR 中的样条项和死亡率竞争风险，从而在这些特定亚组中实现了更准确的校准，但总体上并没有。
在使用 CKD-EPI 2021 方程时，原始的 KFRE 通常在 eGFR<45ml/min/1.73m2 时具有较高的准确性。纳入竞争风险方法和 eGFR 样条可以改善低风险且时间范围较长的情况下的校准。在大多数情况下，包含历史平均值、eGFR 斜率或竞争风险设计并没有显著改变 KFRE 的性能。
