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KFRE Risk Communication RRT Planning — ESENeph MCQ

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ModerateChronic Kidney DiseaseKFRE Risk Communication RRT PlanningESENeph

A 52-year-old woman has CKD G3b (eGFR 38 mL/min/1.73m2) and is on maximum RASi, SGLT2i, and statin. Her uACR is 25 mg/mmol and BP 126/78 mmHg on amlodipine and ramipril. Using the KFRE (Kidney Failure Risk Equation) 5-year risk calculator, her predicted risk of kidney failure within 5 years is 4%. What does this risk estimate MOST usefully inform?

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Correct answer: C — Timing of referral for renal replacement therapy education

The KFRE (Kidney Failure Risk Equation) integrates age, sex, eGFR, and uACR to predict 2-year and 5-year risk of kidney failure (eGFR <15 or KRT). KDIGO 2024 recommends using KFRE to guide timing of RRT education, access planning, and transplant referral. A 5-year risk of 4% is low, indicating that intensive RRT planning is not yet needed, but this patient should continue nephrology follow-up with serial KFRE recalculation. NICE recommends RRT education when 5-year risk exceeds 10-20%, and access formation when risk exceeds 20%. The KFRE empowers individualised planning rather than eGFR-threshold-based triggers.

Reference: https://guidelines.ukkidney.org