Kidney Failure Risk Equation May Improve Vascular Access Planning – Renal and Urology News

Using the kidney failure risk equation (KFRE) in addition to estimated glomerular filtration rate (eGFR) for vascular access planning may help more patients start hemodialysis with an arteriovenous fistula or graft while minimizing too-early creation, investigators suggest.

Mohammad Atiquzzaman, PhD, of The University of British Columbia in Vancouver, Canada, and colleagues conducted a retrospective study of 2581 adults referred for vascular access creation when their eGFR declined to less than 15-20 mL/min/1.73m². Timely preemptive creation of an arteriovenous fistula or graft within 2 years of hemodialysis initiation occurred in a significantly greater proportion of patients with vs without an adjunctive KFRE score of 40% or higher: 58% vs 49%, the investigators reported in Clinical Kidney Journal.

Using the adjunct 2-year KFRE score set at a threshold of more than 40% also appeared to significantly reduce too-early creation of vascular access compared with the current referral system: 18% vs 31% of the patient groups, respectively, did not start hemodialysis within 2 years of arteriovenous fistula or graft creation.

“Taken together, these findings support the use of a KFRE-2 based threshold of >40% in addition to an eGFR of 15–20 mL/min/1.73 m² to trigger the creation of [vascular access],” Dr Atiquzzaman’s team wrote.

However, the investigators also found that 366 of the 2581 patients (14%) who had an adjunct KFRE of 40% or less also needed to start hemodialysis within 2 years.

According to the investigators, future research is needed to validate these findings and improve vascular access creation referral for patients with an adjunct KFRE of 40% or less.

Of the 2581 patients, 61% started hemodialysis and 11% died before dialysis initiation within 2 years. Only 43% started hemodialysis with a working arteriovenous fistula or graft. Of the remaining 57% who started hemodialysis with a central venous catheter, 49% eventually switched to an arteriovenous fistula or graft.