Use of the kidney failure risk equation to inform clinical care of patients with chronic kidney disease: a mixed-methods systematic review

RATIONALE AND OBJECTIVE: The Kidney Failure Risk Equation (KFRE) predicts the risk of end-stage kidney disease in patients with chronic kidney disease (CKD). This study aimed to evaluate the impact of the utility of KFRE in clinical practice. STUDY DESIGN: Systematic review. SETTING AND STUDY POPULATIONS: Adult patients with CKD but not receiving renal replacement therapy enrolled in studies where KFRE was used in clinical care pathways. SELECTION CRITERIA FOR STUDIES: All studies published from April 2011 to October 2021 identified from Medline, Cumulative Index to Nursing and Allied Health Literature, Embase and reference and citation searches of included studies. DATA EXTRACTION: Relevant data were extracted, and two reviewers independently assessed study quality using appropriate appraisal tools. ANALYTICAL APPROACH: Findings reported as a narrative synthesis due to heterogeneity of the included studies. RESULTS: Of 1635 studies identified, 440 duplicates were removed. The remaining 1195 titles and abstracts were screened. All five studies for full-text review were included in the analysis. Three uses of KFRE were assessed: (1) primary to specialty care interface; (2) general nephrology to multidisciplinary care transition; and (3) treatment planning. Evidence of impact on number of patient referrals into nephrology care was conflicting. However, wait times improved in one study. Although KFRE identified high-risk patients for increased multidisciplinary support, there was concern patients stepped down, no longer meeting eligibility criteria, may lack access to services. CONCLUSIONS: This is the first systematic review of studies that have assessed the actual impact of KFRE in clinical practice with five studies of varying quality reported to date. Trials are in progress assessing the impact on clinical outcomes of using KFRE in clinical practice, and KFRE is being incorporated into guidelines for CKD management. Further studies are needed to assess the impact of KFRE on clinical care. TRIAL REGISTRATION NUMBER: Protocol registered on PROSPERO before initiation of the study (Ref: CRD42020219926).