Kidney Failure Risk Equation
Predict 2-year and 5-year risk of kidney failure requiring dialysis or transplant. Validated for CKD stages 3-5 using age, sex, eGFR, and urine ACR.
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5-year >10%: nephrology referral 2-year >20%: access planning ACR strongest predictor
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Why: KFRE guides nephrology referral timing and dialysis modality education.
How: 4-variable model uses age, sex, eGFR, and log-transformed ACR. Risk = 1 - S₀^exp(LP).
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Low Risk CKD Stage 3a
Older patient with mild CKD, minimal proteinuria
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Moderate Risk CKD Stage 3b
Middle-aged diabetic with moderate proteinuria
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High Risk CKD Stage 4
Patient with severe proteinuria and low eGFR
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Young Rapid Progressor
Young patient with nephrotic-range proteinuria
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Elderly Stable CKD
Elderly patient with stable CKD stage 4
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Sample Clinical Scenarios — Click to Load
Patient Information
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
4 core variables
— Tangri et al.
10% 5-year referral threshold
— KDIGO
📋 Key Takeaways
- • KFRE predicts 2-year and 5-year risk of kidney failure requiring dialysis or transplant
- • Validated for CKD stages 3-5; 4-variable model uses age, sex, eGFR, and urine ACR
- • 5-year risk >10% warrants nephrology referral; >20% 2-year risk suggests access planning
- • ACR is the strongest predictor—proteinuria dramatically affects risk
💡 Did You Know?
📖 How KFRE Works
Step 1: Gather Laboratory Values
Obtain eGFR (CKD-EPI preferred) and spot urine albumin-to-creatinine ratio (ACR).
Step 2: Apply Risk Equation
The KFRE uses Cox proportional hazards model with validated coefficients. ACR is log-transformed.
Step 3: Calculate Risk Probability
The equation outputs 2-year and 5-year probabilities of kidney failure requiring dialysis or transplant.
Step 4: Guide Clinical Decisions
Risk thresholds inform referral timing (>10% 5-year), access planning (>20% 2-year), and modality education (>40% 2-year).
🎯 Expert Tips
💡 ACR is the Strongest Predictor
Urine ACR has the highest coefficient. A 10-fold increase in ACR dramatically increases predicted risk.
💡 Trajectory Matters
Serial KFRE calculations reveal disease trajectory. Worsening KFRE may warrant intensification.
💡 Conservative Care Consideration
For elderly or frail patients with high KFRE, discuss goals of care and conservative non-dialytic management.
💡 Shared Decision-Making
Present KFRE results in accessible terms. Visual aids can facilitate understanding and care planning.
⚖️ Risk Thresholds for Clinical Action
| Risk Level | 5-Year Risk | Clinical Action |
|---|---|---|
| Low | <3% | Annual monitoring, primary care management |
| Intermediate | 3-10% | Consider nephrology referral |
| High | 10-40% | Nephrology co-management, access planning |
| Very High | >40% | KRT education, access creation, transplant referral |
❓ Frequently Asked Questions
Is KFRE accurate for all CKD patients?
KFRE is validated for CKD stages 3-5. It may be less accurate in early CKD (stages 1-2), rapidly progressive diseases, or populations not represented in the derivation cohort.
Should I use 4-variable or 8-variable KFRE?
The 4-variable model is simpler and widely applicable. The 8-variable model offers improved accuracy in advanced CKD (eGFR less than 30) when additional lab values are available.
How often should KFRE be recalculated?
Recalculate KFRE annually or when significant changes in eGFR or proteinuria occur. Trend analysis can help identify patients with accelerating progression.
Can KFRE account for interventions?
KFRE provides a snapshot based on current values. Interventions like RAAS blockade or SGLT2 inhibitors may reduce actual risk below the predicted value.
Why does age have a negative coefficient?
Older patients are less likely to reach dialysis because competing risks (death from other causes) increase with age.
Does KFRE apply to transplant recipients?
KFRE was not validated in transplant populations. Graft failure prediction requires specific models.
What if my patient has AKI on CKD?
KFRE should be calculated using stable baseline values, not during acute kidney injury episodes.
Can KFRE guide medication dosing?
No, KFRE is for prognosis only. For medication dosing, use eGFR directly.
📊 KFRE by the Numbers
📚 Official Data Sources
⚠️ Disclaimer: This calculator is for educational purposes. It should not replace professional medical advice. Treatment decisions require nephrology consultation based on individual circumstances. KFRE provides estimates; clinical judgment is essential.
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