KFRE (4 Variable Kidney Failure Risk Equation)

Clinical Chemistry

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Description

The ”CKD Monitoring” request on ICE is now the recommended way of monitoring kidney function in CKD patients. This request consists of both urea and electrolytes but also a urinary ACR. Therefore, using this request will hopefully increase urinary ACR testing in CKD which is important as high levels of albuminuria in CKD patients may trigger the use of kidney protective agents such as SGLT2 inhibitors.

In addition to getting eGFR and uACR results, a Kidney Failure Risk Equation (KFRE) score will be generated on ICE for all patients with an eGFR <60 ml/min/1.73m^2who have a urinary ACR measured within a week of the eGFR. The KFRE is a validated tool that quantifies the risk of needing dialysis or a transplant over a 5-year period. So, if a patient has a KFRE score of 10% that means that there is a 10% chance that the patient will need dialysis or a transplant in the next 5 years. This is important to know about as the new NICE CKD guidelines suggest that rather than referring all patients with an eGFR<30mls/min to Nephrology we should only refer/discuss those with a consistent KFRE score of greater than 5% over 5 years. The KFRE does not account for competing risk of death – so in elderly, comorbid patients a high KFRE score does not necessarily mean that a patient will need dialysis in their lifetime as they may die of something else before they get to the point of needing dialysis. In such patients rather than referring patients to Nephrology it will be more appropriate to seek advice and guidance from Nephrology, using the NHS e-referral service.

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Indications

Patients with renal disease (known eGFR <60 ml/min/1.73m^2) for monitoring and indication of when referral to renal services might be required.

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Sample Type

Early morning urine, no preservative, 2 mL; Serum, SST/Gel, minimum 2 mL (1 mL separated serum)

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Reference Range

Reference ranges are provided on the report. Alternatively, please contact the laboratory for current ranges.

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Turnaround Time

24 Hours

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Testing Frequency

As required

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Please note: the above information is subject to change and we endeavour to keep this website up to date wherever necessary.