The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

Salman Ahmed; Suraj Sarvode Mothi; Thomas Sequist; Navdeep Tangri; Roaa M Khinkar; Mallika L Mendu

doi:10.1016/j.xkme.2021.08.010

The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

Kidney Med. 2021 Oct 15;4(1):100375. doi: 10.1016/j.xkme.2021.08.010. eCollection 2022 Jan.

Authors

Salman Ahmed¹, Suraj Sarvode Mothi¹, Thomas Sequist^{2

3

4}, Navdeep Tangri⁵, Roaa M Khinkar^{3

6}, Mallika L Mendu^{1

3

7}

Affiliations

¹ Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
² Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
³ Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁴ Partners HealthCare, Department of Quality, Patient Experience and Equity, Boston, MA.
⁵ Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
⁶ Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
⁷ Partners HealthCare, Center for Population Health, Boston, MA.

Abstract

Rationale & objective: The 4-variable kidney failure risk equation (KFRE) allows for the prediction of chronic kidney disease (CKD) progression using age, sex, estimated glomerular filtration rate, and urine albumin/creatinine ratio. Electronic health records enable KFRE auto-calculation, and registries allow population-level application. We assessed whether 2-year KFRE score categories are associated with CKD care metrics.

Study design: Cross-sectional cohort.

Setting & participants: This study included individuals with CKD in March 2020 who were receiving care within the Partners HealthCare system in Massachusetts.

Outcomes: The presence of sufficient data to calculate the KFRE and, among those with a KFRE score, performance on CKD clinical care metrics, including (1) prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (2) blood pressure at goal (<140/90 mm Hg) based on clinic measurements; (3) composite metric of hepatitis B virus immunity; (4) composite metric of referral, evaluation, or waitlist status for kidney transplantation; (5) advance directive documentation; (6) yearly influenza vaccination; and (7) pneumonia vaccination.

Analytical approach: Multivariable logistic regression analysis was used to analyze the association of KFRE score category with CKD care metrics.

Results: Of 61,546 patients, 18,272 (30%) had auto-calculated 2-year KFRE scores; the remaining patients lacked KFRE scores because of absent albuminuria assessment. Individuals with a KFRE score were more likely to have a primary care provider or nephrologist. Among patients with 2-year KFRE scores, high-risk patients had increased odds of completing advance directives (OR, 1.52; 95% CI, 1.07-2.17), while low-risk patients had decreased odds of influenza vaccination (OR, 0.85; 95% CI, 0.75-0.97). Patients with moderate- and high-risk KFRE scores had lower odds of having blood pressure at goal (OR, 0.77; 95% CI, 0.61-0.96 and OR, 0.63; 95% CI, 0.44-0.88, respectively).

Limitations: Albuminuria data may have been assessed outside of the Partners system.

Conclusions: A higher-risk KFRE score is associated with the delivery of some but not all CKD care measures. An opportunity exists to improve albuminuria measurement.

Keywords: Chronic kidney disease; kidney failure risk equation; quality improvement; urine albumin/creatinine ratio.