Kidney Failure Risk Equation (KFRE)
The Kidney Failure Risk Equation (KFRE) is a risk prediction model to measure the 2-year and 5-year risk of end-stage kidney disease in people with chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2. The model was developed initially in Canada and its accuracy was subsequently validated in over 30 countries.
Benefits of Using the KFRE
The 5-year KFRE ≥ 5% criterion captures higher risk patients, some of whom are missed by existing referral criteria:
- While the eGFR helps increase recognition of chronic kidney disease, it does not predict risk of progression in isolation.
- The KFRE incorporates proteinuria, age and sex, and is a more effective predictor of end-stage kidney disease than eGFR alone.
Earlier identification of patients at risk of progression to end-stage kidney disease leads to improved care:
- Earlier referral of high risk patients to nephrology has been shown to improve survival and reduce healthcare costs.
- The KFRE can be used to better tailor advice and treatment for an individual chronic kidney disease patient, improve patient understanding, ensure the patient’s care needs are met and minimize risk of progression to end-stage kidney disease.
- Use of a risk-based triage scheme with the KFRE has been shown to improve wait times and access to care for patients at highest risk of progression to end-stage kidney disease.
Using the KFRE in Your Primary Care Practice
- Obtain your patient’s eGFR and urinary albumin-to-creatinine ratio (ACR)
- Suggestion: calculate the KFRE if eGFR is less than 60 ml/min/1.73m2
- To calculate the KFRE, visit the kidney failure risk calculator:
- Enter your patient’s age, sex, eGFR and ACR
- Monitor and manage your lower-risk patient with the KidneyWise Clinical Toolkit if the 5-year KFRE is < 5%
- Consider referring patient to nephrology if the 5-year KFRE result is ≥ 5%
- KidneyWise Clinical Algorithm – Find information on identification and management of chronic kidney disease patients, as well as additional referral criteria.
- Outpatient Nephrology Referral Form – Find out what type of information to include in your referral to nephrology.
Sign Up for eConsult
Do you have questions about your patient that you’d like to ask a nephrologist? Sign up for the Ontario eConsult Program and ask one of the 40+ nephrologists registered. Feedback on the program has been very positive from referring healthcare providers, specialists and patients.
Email eConsultCOE@toh.ca to learn how to make eConsult a regular part of your practice.