Predicting ESRD in Patients with CKD

Educational Objectives

Summary

Predicting ESRD in Patients with Chronic Kidney Disease

In patients with chronic kidney disease, an important use of the estimated glomerular filtration rate (eGFR) is to predict progression to end-stage renal disease (ESRD) so that clinicians can initiate appropriate interventions — including referral for specialist care — in a timely fashion. A tool called the Kidney Failure Risk Equation (KFRE https://qxmd.com/calculate/calculator_308/kidney-failure-risk-equation-4-variable) uses four variables — age, sex, eGFR, and urinary albumin–creatinine ratio — to generate an estimate of 2-year risk for progression to ESRD.

In a study on the website of the Annals of Internal Medicine (https://doi.org/10.7326/M21-2928), researchers sought to determine whether adjustment for race contributes to the KFRE’s predictive accuracy in 3900 U.S. patients with chronic kidney disease (mean follow-up, >9 years). To do so, they compared KFRE predictions of end-stage renal disease using eGFR from the 2021 version of the CKD-EPI equation (https://www.mdcalc.com/ckd-epi-equations-glomerular-filtration-rate-gfr) — which does not incorporate race — and earlier versions that did incorporate race. (Note: Laboratories commonly use the CKD-EPI equations to report eGFR results that appear alongside serum creatinine results.)

With both the 2021 and earlier versions of GFR estimates, KFRE significantly improved the accuracy of predicting 2-year incidence of ESRD, compared with using eGFR alone. The race adjustment in earlier versions of eGFR did not have a relevant effect on ESRD prediction.

In this analysis, race is not a clinically necessary component for estimating GFR or predicting ESRD. Moreover, the KFRE — which includes the urinary albumin–creatinine ratio — leads to better predictions than does eGFR alone. The National Kidney Foundation and American Society of Nephrology recommend using the new CKD-EPI equations (without race) for eGFR in U.S. laboratories.

Daniel D. Dressler, MD, MSc, MHM, FACP & Allan S. Brett, MD

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

JW330512

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

More Details - Certification & Accreditation