Kidney Disease Progression: How to Calculate Risk

Q)When I diagnose patients with minor kidney disease, they often ask if they will require dialysis. I know it is unlikely, but I wish I could give them a better answer. Can you help me?

The diagnosis of chronic kidney disease (CKD) is understandably concerning for many patients. Being able to estimate CKD progression helps patients gain a better understanding of their condition while allowing clinicians to develop more personalized care plans. Tangri and colleagues developed a model that can be used to predict risk for kidney failure requiring dialysis or transplantation in patients with stage III to V CKD. This model has been validated in multiple diverse populations in North America and worldwide.¹

The Kidney Failure Risk Equation (found at www.kidneyfailurerisk.com) uses four variables—age, gender, glomerular filtration rate (GFR), and urine albumin-to-creatinine ratio (ACR)—to assess two- and five-year risk for kidney failure.^1,2 For example

• A 63-year-old woman with a GFR of 45 mL/min and an ACR of 30 mg/g has a 0.4% two-year risk and a 1.3% five-year risk for progression to kidney failure requiring dialysis or transplant.¹
• Alternatively, a 55-year-old man with a GFR of 38 mL/min and an ACR of 150 mg/g has a 2.9% two-year risk and a 9% five-year risk for progression to end-stage renal disease (ESRD).¹