Kidney Failure Risk Equation Validated in Children

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The tool demonstrated strong discrimination for ESRD risk in children over the short term.
The tool demonstrated strong discrimination for ESRD risk in children over the short term.

The kidney failure risk equation (KFRE) used for adults also accurately predicts short-term risks for end-stage renal disease (ESRD) in children, according to a new study.

Erica Winnicki, MD, of the University of California, San Francisco, and colleagues, tested the 4-variable and 8-variable KFRE in 603 children with estimated glomerular filtration rates (eGFR) below 60 mL/min/1.73 m2 from the Chronic Kidney Disease in Children Cohort Study (CKID) 2005–2013. The 4-variable KFRE included age, sex, bedside Schwartz eGFR, and urinary albumin to creatinine ratio, whereas the 8-variable tool added serum calcium, phosphate, bicarbonate, and albumin levels. Three-quarters of the children (62.7% male; median age 12) had a nonglomerular type of kidney disease.

Nearly a quarter of pediatric patients (23.9%) progressed to ESRD within 5 years, according to results published online in JAMA Pediatrics. A few factors were associated with a more than 13% greater risk for progression within 2 years: male sex, higher blood pressure, and lower hemoglobin levels. Both the 4- and 8-variable KFRE scores showed a high degree of discrimination for ESRD risk at 1 and 2 years.

“We propose that this equation be incorporated into the clinical care of children with CKD to aid clinicians, patients, and their families in planning for end stage care,” Dr Winnicki and her colleagues stated. They suggested that KFRE results could improve timing of referral for transplant evaluation and planning for dialysis access. An online version of the 4-variable tool is available at https://qxmd.com/calculate/calculator_308/kidney-failure-risk-equation-4-variable,

“This validation study is an important contribution to the pediatric nephrology community that has the potential to change clinical practice as it has in the adult CKD population,” Allison Dart, MD, MSc, Paul Komenda, MD, MHA, and Navdeep Tangri, MD, PhD, of the University of Manitoba in Winnipeg, wrote in an accompanying editorial.

They also observed: “The results support that the KFRE is reliable for estimating 1- to 2-year risk of kidney failure in children aged 1 to 16 years.” The results for 5-year risk may be less accurate, they noted.

References

Winnicki E, McCulloch CE, Mitsnefes MM, Furth SL, Warady BA, and Ku E. Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.4083. Epub December 18, 2017.

Dart A, Komenda P, and Tangri N. Time to Implement the Kidney Failure Risk Equation Into Pediatric Practice. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.4092. Epub December 18, 2017.

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