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. 2025 Mar 4;26(1):113.
doi: 10.1186/s12882-025-04043-0.

Analysis of the kidney failure risk equation implementation in routine clinical practice and health inequalities in chronic kidney disease care: a retrospective cohort study

Heather Walker  1 , Shabana Khan  2 , Sandosh Padmanabhan  3 , Jill P Pell  4 , Jim Lewsey  5 , Daniel Mackay  4 , Ruth Dundas  6 , Jocelyn M Friday  3 , Tran Q B Tran  3 , Denise Brown  6 , Frederick Ho  4 , Claire E Hastie  4 , Michael Fleming  4 , Claudia Geue  5 , Alan Stevenson  2 , Clea Du Toit  7 , Bhautesh Dinesh Jani  8 , Katie Gallacher  8 , Patrick B Mark  3   9 , Michael K Sullivan  3   9
Affiliations

Analysis of the kidney failure risk equation implementation in routine clinical practice and health inequalities in chronic kidney disease care: a retrospective cohort study

Heather Walker et al. BMC Nephrol. .

Abstract

Background: NICE guidelines recommend GPs use the kidney failure risk equation (KFRE) to identify people with chronic kidney disease (CKD) at higher risk of kidney failure. Albuminuria results are required to calculate KFRE.

Aim: Analyse the implementation of KFRE into clinical practice and investigate if albuminuria testing varied amongst patients with CKD, particularly for underserved groups.

Design and setting: Retrospective cohort study of 23,063 adults in Glasgow from 2013 to 2022.

Method: We evaluated albuminuria testing rates and the predictive performance of KFRE in estimating 5-year kidney failure risk amongst people with CKD. Logistic regression models quantified associations between demographic/clinical variables and albuminuria testing. Amongst people who developed kidney failure, we retrospectively assessed the impact of KFRE on the timing of meeting criteria for referral to renal services.

Results: Albuminuria testing was performed in 44.5% of 10,874 adults with CKD. Females (adjusted odds ratio (aOR) 0.86: 95% CI 0.79-0.93) and those with hypertension (aOR 0.69: 95% CI 0.63-0.77) were less likely to have albuminuria testing. Those aged 40-50 years (aOR 1.83: 95% CI 1.15-2.91), with diabetes (aOR 2.35: 95% CI 2.14-2.58) and living in the least socioeconomically deprived areas (aOR 1.11: 95% CI 1.00-1.23) were more likely to have albuminuria testing. Of 1,352 individuals with incident kidney failure, incorporating KFRE into referral guidelines helped identify high-risk patients early.

Conclusion: KFRE could be calculated for less than half of people due to lack of albuminuria testing. Focus should be given to improving albuminuria testing and inequities identified to allow wider implementation of KFRE.

Keywords: Albuminuria; Chronic kidney disease; Health inequality; Hospital referrals; Kidney failure risk equation.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: PBM reports lecture honoraria from Astrazeneca, Pharmacomsos, Bayer, Astellas, GSK and Boehringer Ingelheim outside the submitted work. The other authors have no potential conflicts of interest to declare. Ethics approval and consent to participate: Delegated research ethics approval was granted for linkage to National Health Service (NHS) patient data by the Local Privacy and Advisory Committee at NHS Greater Glasgow and Clyde. Cohorts and de-identified linked data were prepared by the West of Scotland Safe Haven Research Database at NHS Greater Glasgow and Clyde (IRAS Project ID 321198, REC reference 22/WS/1063, West of Scotland REC 4, https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/west-of-scotland-safe-haven-research-database/ .). Conflicts of interest: The other authors have no potential conflicts of interest to declare. Rights retention statement: For the purpose of open access, the author(s) has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.

Figures

Fig. 1
Fig. 1
Area under receiver operating characteristic (ROC) curve (AUC) demonstrating KFRE’s discrimination at five years
Fig. 2
Fig. 2
Calibration curve demonstrating KFRE’s calibration at five years
See this image and copyright information in PMC

References

    1. Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and National burden of chronic kidney disease, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2020;395(10225):709–33. - PMC - PubMed
    1. Phillips LA, Donovan KL, Phillips AO. Renal quality outcomes framework and eGFR: impact on secondary care. QJM-Int J Med. 2009;102(6):415–23. - PubMed
    1. Royston P, Altman DG. External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol. 2013;13:33. - PMC - PubMed
    1. NICE. Chronic kidney disease: assessment and management 2021 guideline. - PubMed
    1. Hull SA, Nitsch D, Caplin B, Griffith K, Wheeler DC. The National CKD audit: a primary care condition that deserves more attention. Br J Gen Practice: J Royal Coll Gen Practitioners. 2018;68(673):356. - PMC - PubMed

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