CLINICAL UTILITY OF KIDNEY FAILURE RISK EQUATION IN DIABETES AND CHRONIC KIDNEY DISEASE

Authors

  • Ying Guat Ooi
  • Tharsini Sarvanandan
  • Nicholas Ken Yoong Hee
  • Quan Hziung Lim
  • Hooi Chin Beh
  • Nur Raziana Rozi
  • Christine Shamala Selvaraj
  • Adina Abdullah
  • Wan Ahmad Hafiz Wan Md Adnan
  • Sharmila S Paramasivam
  • R. Jeyakantha Ratnasingam
  • Shireene Ratna Vethakkan
  • Pavai Sthaneswar
  • Soo Kun Lim
  • Lee Ling Lim

Keywords:

KIDNEY FAILURE, DIABETES, CHRONIC KIDNEY DISEASE

Abstract

INTRODUCTION/BACKGROUND
Heterogeneity in disease course and prognosis makes managing CKD difficult. An accurate risk stratification algorithm is crucial to predict CKD progression to ESKD for individualized management. The Kidney Failure Risk Equation (KFRE), developed in 2011, is the most widely validated prediction model for 2- and 5-year ESKD progression risk across multiple underlying etiologies with potential for clinical utility.

METHODOLOGY
This study aims to investigate if KFRE risk scores differ significantly among individuals with or without diabetes. We conducted a retrospective study on adults with CKD (eGFR 15-59 ml/min/1.73 m2 ) who attended our hospital outpatient follow-up from January to December 2022 with available data for calculation of 4-variable KFREs [age, sex, eGFR, urine albumin-creatinine ratio (uACR)]. Two-sample t-test and Mann-Whitney U test were performed to analyse the difference between the two groups.

RESULTS
Out of 10,391 adults with CKD, 1,823 that fulfilled the inclusion criteria were analysed, with a mean age of 70 years, 52% were male, mean eGFR of 45ml/min/1.73 m2 and median uACR of 8.4 mg/mmol. Majority (84%) have diabetes with a mean HbA1c of 7.8%. Individuals with CKD and diabetes had lower eGFR, heavier albuminuria and had younger age than those without diabetes (p <0.001). These findings further translate to statistically significant higher KFRE risk scores for individuals with diabetes. For those with eGFR between 30-59 ml/min/1.73 m2 , 9.4% of individuals without diabetes and 14.8% of those with diabetes met the referral criteria for nephrology care when setting a KFRE score threshold of more than 5% over 5 years.

CONCLUSION
The lack of uACR monitoring resulted in a smaller sample size than anticipated. We advocate all healthcare professionals to monitor uACR and utilize the KFRE score in clinical practice when managing CKD or diabetes with eGFR between 15-60 ml/min/1.73 m2 to guide referral to multi-disciplinary care and raise public awareness about the risk of ESKD.

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Author Biographies

Ying Guat Ooi

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Tharsini Sarvanandan

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Nicholas Ken Yoong Hee

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Quan Hziung Lim

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Hooi Chin Beh

Department of Primary Care Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Nur Raziana Rozi

Nephrology Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Christine Shamala Selvaraj

Department of Primary Care Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Adina Abdullah

Department of Primary Care Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Wan Ahmad Hafiz Wan Md Adnan

Nephrology Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Sharmila S Paramasivam

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

R. Jeyakantha Ratnasingam

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Shireene Ratna Vethakkan

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Pavai Sthaneswar

Department of Pathology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Soo Kun Lim

Nephrology Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Lee Ling Lim

Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

References

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Published

2024-07-17

How to Cite

Ooi, Y. G., Sarvanandan, T. ., Hee, N. K. Y. ., Lim, Q. H., Beh, H. C. ., Rozi, N. R., Selvaraj, C. S. ., Abdullah, A., Adnan, . W. A. H. W. M., Paramasivam, S. S., Ratnasingam, R. J. ., Vethakkan, S. R., Sthaneswar, P. ., Lim, S. K., & Lim, L. L. (2024). CLINICAL UTILITY OF KIDNEY FAILURE RISK EQUATION IN DIABETES AND CHRONIC KIDNEY DISEASE. Journal of the ASEAN Federation of Endocrine Societies, 39(S1), 3536. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/4493

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