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. 2025 Jun 19.
doi: 10.1007/s40620-025-02286-6. Online ahead of print.

Performance of the Kidney Failure Risk Equation according to diabetic status in the CKD-CAREMEAU cohort of patients with chronic kidney disease

Julien Prouvot  1   2 , Pascal Reboul  1 , Pedram Ahmadpoor  1 , Edouard Clemmer  1 , Marion Gerbal  1 , Florian Garo  1 , Sylvain Cariou  1 , Emilie Pambrun  1 , Ziyad Messikh  1 , Olivier Moranne  3   4   5
Affiliations

Performance of the Kidney Failure Risk Equation according to diabetic status in the CKD-CAREMEAU cohort of patients with chronic kidney disease

Julien Prouvot et al. J Nephrol. .

Abstract

Background: The Kidney Failure Risk Equation (KFRE) estimates the risk of kidney replacement therapy (KRT) at 5 years. Patients with diabetes mellitus are at high risk of KRT and death, a competing event. This study assesses the performance of the 5-year KFRE in patients with diabetes mellitus, compared to non-diabetic patients and considering age, in a cohort of patients evaluated by a nephrologist at a tertiary care center.

Methods: The CKD-CAREMEAU cohort included all patients who visited a nephrologist for chronic kidney disease (CKD) before KRT between 2008 and 2017. The 5-year KFRE was calculated for each patient, based on their baseline characteristics. The study evaluated performance regarding discrimination and calibration, taking the patient's diabetic status and age into account.

Results: The study included 2935 patients with a median age of 73 [65-80] years, 1800 of whom were men (61%), and 1249 (43%) who were affected by diabetes. The incidence of KRT was higher in diabetic patients (167 (13%)) than in non-diabetic patients (184 (11%))(p = 0.04). Additionally, the death rate within five years after inclusion was not statistically higher for diabetic patients (351 (28%)) than non-diabetic patients (443 (26%))(p = 0.3). Diabetic status affected neither discrimination nor calibration. However, the equation overestimated the risk for higher-risk patients, especially among the elderly.

Conclusions: Our study found no difference in the 5-year KFRE performance between diabetic and non-diabetic patients. However, performance was worse for patients over 75 years old.

Keywords: Diabetes mellitus; Kidney failure, chronic; Renal insufficiency, chronic; Risk assessment.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no conflicting interests to declare. Ethical approval: Ethical approval This study was performed in line with the principles of the Declaration of Helsinki and was approved by the ethical committee of Nîmes University Hospital under the IRB number 24.02.02. Informed consent: Patients were informed of the study by letter and were included if they were unopposed to the use of their data from electronic records.

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