학술논문
Kidney Failure Risk Equation in vascular access planning: a population-based study supporting value in decision making
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Source
Clinical Kidney Journal. February 2024, Vol. 17 Issue 2, p1, 8 p.
Subject
Language
English
ISSN
2048-8505
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (CKD) may progress to end-stage kidney disease (ESKD) over time. In most patients reaching ESKD requiring hemodialysis (HD), an arteriovenous fistula/graft (AVF/G) is [...]
Background. The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing estimated glomerular filtration rate (eGFR)-based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods. Patients with CKD aged [greater than or equal to]18 years with eGFR 40% and (iii) eGFR-based referral plus KFRE-2 [less than or equal to]40%. We estimated the proportion of patients who started HD on arteriovenous fistula/graft (AV F/G) within 2 years, indicating timely pre-emptive creation, and the proportion of patients in whom AV F/G was created but did not start HD within 2 years, indicating too-early creation. Results. Study included 2581 patients, median age 71 years, 60% male. Overall, 1562(61%) started HD and 276 (11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AV F/G was significantly higher when KFRE-2 was considered in addition to current referral (49% vs 58%, P-value Conclusions. KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings. Keywords: chronic kidney disease, hemodialysis, KFRE, vascular access
Background. The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing estimated glomerular filtration rate (eGFR)-based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods. Patients with CKD aged [greater than or equal to]18 years with eGFR 40% and (iii) eGFR-based referral plus KFRE-2 [less than or equal to]40%. We estimated the proportion of patients who started HD on arteriovenous fistula/graft (AV F/G) within 2 years, indicating timely pre-emptive creation, and the proportion of patients in whom AV F/G was created but did not start HD within 2 years, indicating too-early creation. Results. Study included 2581 patients, median age 71 years, 60% male. Overall, 1562(61%) started HD and 276 (11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AV F/G was significantly higher when KFRE-2 was considered in addition to current referral (49% vs 58%, P-value Conclusions. KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings. Keywords: chronic kidney disease, hemodialysis, KFRE, vascular access