ArticleClinical kidney journal2026
Planning of kidney replacement therapy in advanced CKD using the KFRE formula in a Spanish multicenter cohort.
Article in Clinical kidney journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Background: The Kidney Failure Risk Equation (KFRE) is widely used to estimate the risk of kidney replacement therapy (KRT), but evidence in real-world multicenter advanced chronic kidney disease (ACKD) cohorts-particularly among older patients with substantial competing mortality-remains limited. Methods: We conducted a multicenter retrospective cohort study including adults with ACKD [baseline estimated glomerular filtration rate (eGFR) <20 ml/min/1.73 m Results: A total of 503 patients were included. During follow-up, 248 patients initiated KRT and 94 died before KRT. The 2-year 4-variable KFRE showed good discrimination [time-dependent AUC 0.82, 95% confidence interval (CI) 0.73-0.91], preserved across age strata. Calibration demonstrated appropriate risk ordering across deciles with mild underestimation (CITL -0.21 by Fine-Gray; Brier score 0.23). In patients aged ≥65 years, a KFRE ≥20% was strongly associated with KRT initiation in competing risk models (subdistribution hazard ratio 5.92, 95% CI: 4.08-8.60). DCA showed positive net benefit across clinically relevant thresholds. Conclusions: In a multicenter Spanish ACKD cohort, the 2-year KFRE demonstrated robust discrimination and acceptable calibration. These findings highlight the clinical utility of the KFRE for risk stratification and KRT planning in older patients with ACKD.
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