Evaluation of Kidney Failure Risk Equation score for vascular access planning in an Australian cohort

The Kidney Failure Risk Equation (KFRE) is a validated tool for assessing the risk of progression to kidney failure requiring renal replacement therapy (RRT). A 2-year KFRE risk threshold of ≥40% may support timely vascular access planning.

To compare the utility of KFRE with traditional estimated glomerular filtration rate (eGFR) thresholds for guiding vascular access planning in an Australian cohort.

This single-centre observational cohort study retrospectively reviewed 580 adult patients referred to a Kidney Disease Education Clinic (KDEC) between 2016 and 2021. Among these, 211 patients who underwent dialysis access formation were analysed. Patient trajectories, including eGFR and 2-year KFRE scores at referral, access formation and dialysis initiation, were described alongside rates of emergency access.

Of 211 patients with access created, 204 commenced dialysis. A median 2-year KFRE of 46% predicted dialysis within 12 months, supporting its use for access planning. Compared with eGFR < 15 mL/min/1.73m², KFRE thresholds (≥40% or ≥ 50%) better identified those at risk. A 2-year KFRE ≥ 50% offered the best balance of sensitivity (70%) and specificity (68%) for predicting dialysis within 12 months, whereas ≥40% was more accurate for forecasting dialysis at 24 months and guiding early education. Emergency access was required in 31.5% of haemodialysis patients with lower eGFR at referral (11 vs 15 mL/min/1.73 m²), higher 2-year KFRE (87% vs 62%) and more preceding hospitalisations (95.4% vs 38.5%) than others.

KFRE-based thresholds improve risk-stratified access planning compared with eGFR alone. A KFRE ≥ 40% supports early referral for modality education and vascular access, tailored to patient and institutional needs.