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^[1] and its accuracy was subsequently validated in over 30 countries.^[2]

The Ontario Renal Network has added a KFRE criterion for nephrology referral to the updated KidneyWise Clinical Toolkit, which is also available in a PDF format.

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.^[3]
The KFRE incorporates proteinuria, age and sex, and is a more effective predictor of end-stage kidney disease than eGFR alone.^[3]

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.^[4]
The KFRE can be used to better tailor advice and treatment for an individual chronic kidney disease patient,^[5] improve patient understanding, ensure the patient’s care needs are met^[6] 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.^[3]

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.