Review of the Kidney Failure Risk Calculator (KFRE)

The kidney failure risk equation (KFRE) predicts the 2- and 5-year risk of kidney failure in stable patients with chronic kidney disease (CKD) stage 3-5. The 4 and 8-variable models were developed and first validated in two independent Canadian cohorts with CKD already referred to nephrology and where kidney failure was the time to initiation of chronic dialysis or kidney transplantation. Accurately estimated glomerular filtration rate (GFR) and albuminuria (uACR, spot urine albumin: creatinine ratio) are essential components. The model has since been validated in nearly 1 million individuals from over 30 countries and shown excellent discrimination with a C-statistic ranging between 0.88-0.91. The KFRE complements existing eGFR and albuminuria-based CKD staging and risk classification by providing individualized kidney failure risk estimates. It can help improve prognostic communication and guide broader management decisions specifically, referral to nephrology, multidisciplinary CKD management and kidney replacement therapy planning. It should be re-evaluated on subsequent visits as risk may change based on interval exposures and treatment. While model discrimination has been excellent across diverse cohorts, some studies suggest it may need recalibration in certain groups and CKD etiologies.