#2671 Relationship of the `kidney failure risk equation' with disease progression and cost in chronic kidney disease stages 3–5

Abstract Background and Aims Chronic kidney disease (CKD) significantly impacts healthcare systems and economies. The kidney failure risk equation (KFRE), developed in 2011, predicts the risk of progression to kidney failure more accurately. KFRE may guide better management of healthcare resources and is increasingly used in practice. The primary objectives of this study were to estimate the risk of progression to end-stage kidney disease (ESKD) in patients diagnosed with stage G3-G4 CKD using KFRE and to examine the impact on healthcare resource utilization. Method This single-center, retrospective observational study was conducted in the Department of Nephrology at Hacettepe University Hospitals. Patients aged 18 years and older, with an estimated glomerular filtration rate between 15-60 mL/min/1.73 m² and who were regularly followed up from 2014 to 2019 were included in the study. Patients with missing data at the time of admission, pregnancy status, malignancy, and history of renal replacement therapy were excluded, and a total of 822 patients were included in the study. 4- and 8-variable KFRE were calculated. Stage G3 and G4 CKD patients were analyzed in all risk categories as low, intermediate, and high risk according to KFRE. The term “end stage kidney disease-free survival” (ESKD-fs) was used to report the survival rates of patients who did not undergo dialysis and/or kidney transplantation. Hospital resource use and costs were evaluated separately in all risk categories. Results In stage G3 patients, according to the 4- and 8-variable KFRE, the 5-year ESKD-fs rate was significantly higher in low-risk patients compared to those in the intermediate- and high-risk groups (P < 0.001 and P < 0.001, respectively) (Figs 1 and 2). In stage G4 patients, according to the 4- and 8-variable KFRE, the 2-year ESKD-fs rate was significantly higher in low-risk patients compared to those in the other risk groups (P < 0.001 and P < 0.001, respectively) (Figs 3 and 4). In addition, according to the 4-variable KFRE classification, the median annual outpatient treatment cost in stage G3 patients was found to be $121 in the high-risk group, $98 in the intermediate-risk group, and $94 in the low- risk group (P = 0.017). According to the 4-variable KFRE classification for patients with stage G3, the median annual hospitalization costs were $622 in the high-risk group, $447 in the intermediate-risk group, and $433 in the low-risk group (P = 0.025). According to the 8- variable KFRE classification, the median annual hospitalization costs in patients with stage G3 were $628 in the high-risk group, whereas they were $478 and $423 in the intermediate- and low-risk groups, respectively (P = 0.045). Furthermore, according to the 4- variable KFRE for patients with stages G3 and G4, the median annual hospitalization numbers were significantly higher in the high-risk group (P < 0.001 and P = 0.006, respectively). Conclusion This study demonstrated that KFRE models accurately predict the 2- and 5-year risk of progression to ESKD in patients with stage 3–5 CKD. We demonstrated that patients with stage G3 CKD, who are at higher risk of progression to renal failure according to KFRE, have higher hospital outpatient and hospitalization costs compared to patients in the low-risk category. Effective application of KFRE emerges as a powerful tool for early diagnosis and cost-effective management of at-risk patients.