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

Mohammad Atiquzzaman; Bingyue Zhu; Alexandra Romann; Lee Er; Ognjenka Djurdjev; Micheli Bevilacqua; Michelle M Y Wong; Peter Birks; Tae Won Yi; Anurag Singh; Navdeep Tangri; Adeera Levin

doi:10.1093/ckj/sfae008

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

Clin Kidney J. 2024 Jan 11;17(2):sfae008. doi: 10.1093/ckj/sfae008. eCollection 2024 Feb.

Authors

Mohammad Atiquzzaman^{1

2}, Bingyue Zhu¹, Alexandra Romann¹, Lee Er¹, Ognjenka Djurdjev^{1

3}, Micheli Bevilacqua^{1

2}, Michelle M Y Wong^{1

2}, Peter Birks^{1

2}, Tae Won Yi^{1

2}, Anurag Singh², Navdeep Tangri⁴, Adeera Levin^{1

2}

Affiliations

¹ BC Renal, Vancouver, Canada.
² Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada.
³ Provincial Clinical Policy Analytics and Registry Initiatives, Data Analytics, Reporting and Evaluation, Provincial Health Services Authority, Vancouver, Canada.
⁴ Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada.

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 <.001).

Conclusions: KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings.

Keywords: KFRE; chronic kidney disease; hemodialysis; vascular access.