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Kidney failure risk equation (KFRE) can help identify kidney patients needing less resource-intensive care
A study led by researchers at the University of Calgary in Alberta suggests that the kidney failure risk equation (KFRE) tool can be helpful in identifying kidney patients who can receive less resource-intensive ongoing care without an increased risk of negative outcomes.
The KFRE is a tool doctors can use to estimate a person’s risk of kidney disease progression. Since it was launched in 2017, doctors have been using the KFRE to help guide referral decisions, whereby they are more likely to refer low-risk patients to be cared for by their regular doctor, medium-risk patients by a kidney specialist (nephrologist), and high-risk patients at a multidisciplinary clinic. Care at these clinics can be resource-intensive, but they give kidney patients access to a range of relevant providers — such as nephrologists, nurses, and social workers — through one program/clinic.
Implementation scientist Maoliosa Donald and colleagues conducted a study to explore whether lower and medium-risk patients can be appropriately directed to less resource-intensive care (primary care doctors and nephrologists, respectively) without an increased risk of negative outcomes, such as needing dialysis or a transplant. They analyzed referral records and KFRE data collected in Alberta between April 2017 and March 2019 — capturing a total of 1,748 kidney patients — as well as the patient’s chances of experiencing kidney failure, hospitalization, or death over a two-year period after their referral using the KFRE.
Study results show that there was a much higher kidney failure risk among patients who remained at or were admitted to a multidisciplinary kidney clinic, at 34.7 per cent, compared with 3.6 per cent of patients who received care from a nephrologist, and just 0.8 per cent who remained with a primary care physician. As well, the rates of emergency department visits, hospitalizations, and death were lower for those assigned to primary care doctors and nephrologists, compared with those managed in the multidisciplinary care setting. These results suggest that the KFRE can safely direct a portion of patients to less resource-intensive care without a higher risk of negative outcomes.
