Kidney Failure Risk Equation in vascular access planning: a population-based study supporting value in decision making

Abstract

Background. The Kidney Failure Risk Equation( KFRE) can play a better role in vascular access( VA) planning in patients with chronic kidney disease( CKD) requiring hemodialysis( HD) . We described the VA creation and utilization pattern under existing estimated glomerular filtration rate( eGFR) -based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods. Patients with CKD aged ≥18 years with eGFR < 20 mL/min/1.73 m2 who chose HD as dialysis modality from January 2010 to August 2020 were included from a population-based database in British Columbia, Canada. Modality selection date was the index date. Exposures were categorized as( i) current eGFR-based referral,( ii) eGFR-based referral plus KRFE 2-year risk score on index date( KFRE-2) > 40% and( iii) eGFR-based referral plus KFRE-2 ≤40%. We estimated the proportion of patients who started HD on arteriovenous fistula/graft( AVF/G) within 2 years, indicating timely pre-emptive creation, and the proportion of patients in whom AVF/G was created but did not start HD within 2 years, indicating too-early creation. Results. Study included 2581 patients, median age 71 years, 60% male. Overall, 1562( 61%) started HD and 276( 11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AVF/G was significantly higher when KFRE-2 was considered in addition to current referral( 49% vs 58%, P -value < .001) . Adjunct KFRE-2 significantly reduced too-early creation( 31% vs 18%, P -value