Enhancing vascular access planning in CKD: validating the 40% KFRE threshold for predicting ESKD in a French...

Area of Science:

• Nephrology
• Vascular Surgery
• Epidemiology

Background:

• Optimal timing for vascular access creation in chronic kidney disease (CKD) is crucial for patient management.
• Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a 40% 2-year threshold using the Kidney Failure Risk Equation (KFRE).
• The comparative effectiveness of the KFRE threshold versus traditional estimated glomerular filtration rate (eGFR) thresholds remains unclear.

Purpose of the Study:

• To compare the predictive accuracy of a ≥40% 2-year KFRE threshold against a <15 mL/min/1.73 m² eGFR threshold for end-stage kidney disease (ESKD).
• To evaluate the utility of KFRE in guiding vascular access planning for CKD patients.

Main Methods:

• Retrospective cohort study of 238 CKD patients undergoing vascular mapping for arteriovenous fistula (AVF) creation.
• Comparison of 1-year ESKD prediction using ≥40% 2-year KFRE versus <15 mL/min/1.73 m² eGFR.
• Analysis included death before AVF creation as a competing risk and evaluated discrimination using C-statistics.

Main Results:

• A ≥40% 4-variable KFRE threshold predicted 1-year ESKD with 77.6% probability, compared to 65.8% for <15 mL/min/1.73 m² eGFR.
• The 8-variable KFRE demonstrated superior predictive ability at 6 months (C-statistic 0.82) and comparable 1-year prediction to the 4-variable KFRE.
• Sensitivity and specificity analyses favored the KFRE threshold over the eGFR threshold.

Conclusions:

• The ≥40% 2-year KFRE threshold is a promising tool for vascular access planning in CKD patients.
• This KFRE threshold appears superior to the traditional eGFR threshold for predicting ESKD.
• Utilizing KFRE may help balance timely AVF creation with the risk of central venous catheter use for dialysis.