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

• Published in: BMJ open Vol. 12; no. 1; p. e055572
• Main Authors: Bhachu, Harjeet Kaur, Fenton, Anthony, Cockwell, Paul, Aiyegbusi, Olalekan, Kyte, Derek, Calvert, Melanie
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 18.01.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; chronic renal failure; Clinical medicine; Consultants; dialysis; end stage renal failure; Humans; Job satisfaction; Kidney diseases; Kidney Failure, Chronic - therapy; Mixed methods research; Nephrology; Patients; Referral and Consultation; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Renal Medicine; Renal replacement therapy; renal transplantation; Systematic review; Variables; Canada; Manitoba Canada; Calgary Alberta Canada; United States > US; dialysis; chronic renal failure; renal transplantation; end stage renal failure
• DOI: 10.1136/bmjopen-2021-055572
• ISSN: 2044-6055

Rationale and objectiveThe 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 designSystematic review.Setting and study populationsAdult patients with CKD but not receiving renal replacement therapy enrolled in studies where KFRE was used in clinical care pathways.Selection criteria for studiesAll 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 extractionRelevant data were extracted, and two reviewers independently assessed study quality using appropriate appraisal tools.Analytical approachFindings reported as a narrative synthesis due to heterogeneity of the included studies.ResultsOf 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.ConclusionsThis 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 numberProtocol registered on PROSPERO before initiation of the study (Ref: CRD42020219926).