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The following is a summary of “Estimates of ESKD risk and timely kidney replacement therapy education,” published in the September 2024 issue of Nephrology by Haggerty et al.

Kidney replacement therapy (KRT) timing is unpredictable, and nephrologists often overestimate the risk compared to the Kidney Failure Risk Equation (KFRE).

Researchers conducted a retrospective study to explore the discrepancy between physician-estimated risk and KFRE-calculated risk about referrals for KRT education.

They analyzed data from chronic kidney disease (CKD) clinics at the Veterans Affairs Medical Center San Diego and the University of California, San Diego. They involved 257 participants aged 18 or older who spoke English and were prevalent clinic patients with CKD. They had an estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m² (MDRD equation). The exposure consisted of end-stage kidney disease (ESKD) risk predictions. Nephrologists estimated the risk of needing dialysis or a kidney transplant in 2 years on a scale of 0–100% without using any equations; KFRE was calculated using age, sex, eGFR, serum bicarbonate, albumin, calcium, phosphorus, and urine albumin/creatinine ratio. Outcomes-based on referral patterns to KRT education within 90 days of the initial visit and KF through chart review were assessed. The participants were grouped by nephrologists’ predictions or by KFRE. The sensitivity and specificity of referral to KRT education were calculated based on whether participants developed KF within 2 years.

The results showed that 20% of participants were referred for education within 90 days. According to both estimates, patients with low risk had low referral rates. For those with nephrologists’ predictions ≥15% (n = 137), sensitivity was 71% and specificity was 76%. For patients with KFRE ≥15% (n = 55), sensitivity was 85%, and specificity was 41%.

They concluded that despite nephrologists’ tendency to overestimate, KFR may not act, as KRT education referrals were lower than expected for patients at high risk.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03687-8