Validation of the Kidney Failure Risk Equation in Kidney Transplant Recipients.

Predicting allograft failure in kidney transplant recipients can help plan renal replacement therapy and guide patient-provider communication. The kidney failure risk equation (KFRE) accurately predicts the need for dialysis in patients with chronic kidney disease (CKD), but has not been validated in kidney transplant recipients. We sought to validate the 4-variable KFRE (age, sex, estimated glomerular filtration rate [eGFR], and urine albumin-to-creatinine ratio [ACR]) for prediction of 2- and 5-year death-censored allograft failure. Retrospective cohort study. Four independent North American Cohorts from Ontario, Canada; Alberta, Canada; Manitoba, Canada; and Wisconsin, United States, between January 1999 and December 2017. Adult kidney transplant patients at 1-year posttransplantation. Kidney failure risk as measured by the KFRE (eGFR, urine ACR, age, and sex). We included all adult patients who had at least 1 serum creatinine and at least 1 urine ACR measurement approximately 1 year following kidney transplantation. The performance of the KFRE was evaluated using the area under the receiver operating characteristic curve (C-statistic). C-statistics from the 4 cohorts were meta-analyzed using random-effects models. A total of 3659 patients were included. Pooled C-statistics were good in the entire population, at 0.81 (95% confidence interval: 0.72-0.91) for the 2-year KFRE and 0.73 (0.67-0.80) for the 5-year KFRE. Discrimination improved among patients with poorer kidney function (eGFR < 45 mL/min/1.73 m2), with a C-statistic of 0.88 (0.78-0.98) for the 2-year KFRE and 0.83 (0.74-0.91) for the 5-year KFRE. The KFRE does not predict episodes of acute rejection and there was heterogeneity between cohorts. The KFRE accurately predicts kidney failure in kidney transplant recipients at 1-year posttransplantation. Further validation in larger cohorts with longer follow-up times can strengthen the case for clinical implementation.

Tangri N ，Ferguson TW ，Wiebe C ，Eng F ，Nash M ，Astor BC ，Lam NN ，Ye F ，Shin JI ，Whitlock R ，Yuen DA ... -  《-》

Validation of the Kidney Failure Risk Equation in Manitoba.

Whitlock RH ，Chartier M ，Komenda P ，Hingwala J ，Rigatto C ，Walld R ，Dart A ，Tangri N ... -  《-》

The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study.

Major RW ，Shepherd D ，Medcalf JF ，Xu G ，Gray LJ ，Brunskill NJ ... -  《-》

The Kidney Failure Risk Equation for Prediction of Allograft Loss in Kidney Transplant Recipients.

The Kidney Failure Risk Equation (KFRE) is a simple widely validated prediction model using age, sex, estimated glomerular filtration rate, and urinary albumin-creatinine ratio to predict the risk for end-stage kidney disease. Data are limited for its applicability to kidney transplant recipients. Validation study of the KFRE as a post hoc analysis of the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) Trial. Adult kidney transplant recipients with functioning kidney allografts at least 6 months posttransplantation from 30 centers in the United States, Canada, and Brazil. Participants with estimated glomerular filtration rates < 60 mL/min/1.73 m2 at study entry were included. 2- and 5-year kidney failure risk predicted by the KFRE using variables at study entry. Graft loss, defined by initiation of dialysis. Discrimination of the KFRE was assessed using C statistics; calibration was assessed by plotting predicted risk against observed cumulative incidence of graft loss. 2,889 participants were included. Within 2 years, 98 participants developed graft loss, 107 participants died with a functioning graft, and 129 participants were lost to follow-up, and by 5 years, 252 had developed graft loss, 265 died with a functioning graft, and 1,543 were lost to follow-up. The KFRE demonstrated accurate calibration and discrimination (C statistic, 0.85 [95% CI, 0.81-0.88] at 2 years and 0.81 [95% CI, 0.78-0.84] at 5 years); performance was similar regardless of donor type (living vs deceased) and graft vintage, with the noted exception of poorer calibration for graft vintage less than 2 years. Unavailable cause of graft loss. The KFRE accurately predicted the risk for graft loss among adult kidney transplant recipients with graft vintage longer than 2 years and may be a useful prognostic tool for nephrologists caring for kidney transplant recipients.

Chu CD ，Ku E ，Fallahzadeh MK ，McCulloch CE ，Tuot DS ... -  《-》

A validation study of the 4-variable and 8-variable kidney failure risk equation in transplant recipients in the United Kingdom.

Ali I ，Kalra PA 《BMC Nephrology》