Interpretation
| Result | Meaning |
|---|---|
| 5-yr < 3% | Low risk |
| 5-yr 3–5% | Consider referral |
| 5-yr ≥ 5% | Nephrology referral |
| 2-yr ≥ 10% | Multidisciplinary care |
| 2-yr > 40% | Plan kidney replacement therapy |
Formula
Risk = 1 − S₀^exp(L); L = −0.2201 × (age/10 − 7.036) + 0.2467 × (male − 0.5642) − 0.5567 × (eGFR/5 − 7.222) + 0.4510 × (ln ACR [mg/g] − 5.137). S₀ North America: 0.9750 (2 y), 0.9240 (5 y); non-North America: 0.9832 (2 y), 0.9365 (5 y). ACR mg/mmol × 8.84 = mg/g.
Clinical pearls
- Validated in CKD G3–G5 (eGFR <60); not for AKI, dialysis or transplant recipients.
- Use a race-free CKD-EPI eGFR and an ACR (not PCR); if only PCR is available, convert cautiously.
- Predicts kidney failure treated with dialysis or transplant, not death; in older adults competing mortality risk is high.
Examples
kfre 70 yo male egfr 30 acr 300 mg/gkidney failure risk 55F eGFR 45 ACR 3.4 mg/mmoltangri risk for a 60 year old man with gfr 15 and acr 1000
FAQ
What KFRE risk should prompt nephrology referral?
KDIGO 2024 suggests referral at a 5-year kidney failure risk of 3–5% or higher; many Canadian pathways use 5-year risk ≥3% or ≥5%.
What units does the KFRE use for albuminuria?
Urine ACR in mg/g; multiply mg/mmol by 8.84 to convert.
Evidence
- Tangri N et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA 2011;305:1553–9.
- Tangri N et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA 2016;315:164–74.
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD. Kidney Int 2024;105(4S):S117–S314.