Several kidney failure risk assessment tools, equations, and algorithms are currently used in clinical practice to predict the risk of progression to end-stage kidney disease (ESKD) in patients with chronic kidney disease (CKD). These tools are essential for guiding clinical decision-making and optimizing patient care.
1. Kidney Failure Risk Equation (KFRE): The KFRE is one of the most widely validated and utilized tools. It uses variables such as age, sex, estimated glomerular filtration rate (eGFR), and albumin-to-creatinine ratio (ACR) to predict the risk of treated kidney failure over 2 to 5 years. The KFRE has been validated in diverse populations across more than 30 countries and is known for its high discrimination and calibration.[1-2]
2. CKD-EPI Equations: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations are used to estimate GFR based on serum creatinine and/or cystatin C levels. The CKD-EPI creatinine equation is more accurate than the older Modification of Diet in Renal Disease (MDRD) equation, particularly at higher GFR levels. The CKD-EPI creatinine-cystatin C equation is currently the most accurate method for estimating GFR.[3-5]
3. Kaiser Permanente Northwest (KPNW) Model: This model includes variables such as age, sex, eGFR, albuminuria, systolic blood pressure, antihypertensive use, diabetes, and diabetes complications. It has shown excellent discrimination and calibration for predicting kidney failure over a 5-year period in the Kaiser Permanente Health System.[1][6]
4. Z6 Score: Developed in the German CKD study, the Z6 score uses variables including serum creatinine, albumin, cystatin C, urea, hemoglobin, and ACR. It has been validated in multiple European cohorts and shows good discrimination for predicting kidney failure over 5 years.[1]
5. Veterans Affairs Model: This model is another validated tool that uses routinely collected data from electronic medical records (EMRs) to predict kidney failure risk. It has been validated in various populations, including those in North America.[1]
These tools are integral to the management of CKD, allowing for early identification of patients at high risk for progression to ESKD and enabling timely interventions. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend the use of these validated risk equations to estimate the absolute risk of kidney failure in patients with CKD stages G3-G5.[1]