The Kidney Failure Risk Equation Score and CKD Care Delivery Measures: A Cross-sectional Study

ABSTRACT Rationale & Objective The four-variable kidney failure risk equation (KFRE) allows for chronic kidney disease (CKD) progression prediction, using age, sex, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR). Electronic health records (EHRs) enable KFRE auto-calculation and registries allow population-level application. We assessed whether 2-year KFRE score categories are associated with CKD care metrics. Study Design Cross-sectional cohort Setting & Participants Individuals with CKD in March 2020 receiving care within the Partners' healthcare system in Massachusetts Outcomes Presence of sufficient data to calculate the KFRE and, among those with a KFRE score, performance on CKD clinical care metrics including: 1) prescription of angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB); 2) blood pressure at goal ( Analytical Approach Multivariable logistic regression analysis was utilized to analyze the association of KFRE score category with CKD care metrics. Results Of 61,546 patients, 18,272 (30%) had auto-calculated 2-year KFRE scores; the remaining patients lacked KFRE scores due to absent albuminuria assessment. Individuals with a KFRE score were more likely to have a primary care provider or nephrologist. Among patients with 2-year KFRE scores, "high" risk patients had increased odds of completing advance directives (OR 1.52, 95% CI 1.07-2.17), while "low" risk patients had decreased odds of influenza vaccination (OR 0.85, 95% CI 0.75-0.97). "Moderate" and "high" KFRE risk patients had lower odds of having blood pressure at goal (OR 0.77, 95% CI 0.61-0.96 and OR 0.63, 95% CI 0.44-0.88, respectively). Limitations Albuminuria data may have been assessed outside of the Partners' system Conclusions Higher risk KFRE score is associated with delivery of some but not all CKD care measures. An opportunity exists to improve albuminuria measurement.