Why Is KFRE Gaining Attention?
Chronic Kidney Disease (CKD) is often a “silent” condition. Many patients don’t feel symptoms until their kidneys have deteriorated severely, leading to the sudden need for dialysis.
However, a tool developed in Canada, the Kidney Failure Risk Equation (KFRE), has changed the game. It can predict a person’s risk of progressing to kidney failure within the next 2 or 5 years using common clinical data.
So, how does KFRE work? Is it applicable to Korean patients? What tests are needed to use it, and how should we interpret the results? Let’s break it down.
What Is KFRE?
KFRE is a risk prediction tool created by nephrologists in 2011. It provides a percentage-based estimate of the risk of kidney failure requiring dialysis or transplant in 2 or 5 years.
Unlike basic staging based on eGFR alone, KFRE takes multiple clinical variables into account, offering a more personalized and accurate prognosis for CKD patients.
What Information Does KFRE Require?
KFRE uses 8 key clinical variables:
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Age
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Sex
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eGFR (estimated glomerular filtration rate)
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Serum albumin
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Serum bicarbonate
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Serum phosphate
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Serum calcium
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Urine albumin-to-creatinine ratio (UACR)
These tests are typically available at routine nephrology or internal medicine outpatient visits.
👉 You can try it here: https://www.kidneyfailurerisk.com
Real-Life Example
Two patients, similar eGFRs—very different risks:
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Patient A (Male, 72 years)
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eGFR: 26
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UACR: 1800 mg/g
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Albumin: 3.5 g/dL
→ 2-year dialysis risk: 38% (high risk)
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Patient B (Female, 68 years)
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eGFR: 27
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UACR: 80 mg/g
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Albumin: 4.1 g/dL
→ 2-year dialysis risk: 4% (low risk)
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✅ This shows that KFRE reveals hidden risk differences that eGFR alone can’t.
Is KFRE Applicable to Korean Patients?
🌍 International Validation
KFRE has been validated in over 30 countries and in more than 40 cohorts worldwide, including East Asian populations (Japan, Taiwan, China).
A 2016 meta-analysis published in JAMA confirmed its high predictive accuracy (AUC > 0.9).
🇰🇷 Korean Use Cases
Although large-scale validation studies in Koreans are still limited, some Korean hospitals (e.g., Asan Medical Center, Seoul National University Bundang Hospital) have used KFRE in small patient groups with promising results.
Because KFRE uses routine lab data common in Korean clinical practice, it can be applied. Still, we recommend interpreting results based on risk categories (low, moderate, high) rather than relying solely on exact percentages, due to potential ethnic differences in variables like UACR.
How Can KFRE Be Used in Clinical Practice?
✅ For high-risk patients:
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2-year dialysis risk >20%
→ Initiate fistula planning
→ Begin dialysis education
→ Adjust medications/nutrition support early
✅ For low-risk patients:
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Risk <5%
→ Consider longer follow-up intervals
→ Reduce testing burden and cost
✅ As a communication tool:
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Showing patients numerical risk can help improve adherence to lifestyle changes and treatment.
Helpful Tips
✔ Double-check UACR units: KFRE requires mg/g or mg/mmol
✔ Use lab values from within 1 month
✔ If some lab data are missing, you can still use the 4-variable version (age, sex, eGFR, UACR)
✔ Explain KFRE results to patients with visuals or printed reports
Conclusion:
KFRE Could Transform How We Treat CKD
KFRE marks a shift from traditional staging to multi-factor prediction models. Even in Korean clinical settings, this tool can identify high-risk patients earlier, optimize care pathways, and avoid unnecessary interventions.
If we can predict kidney failure, we can prevent it—KFRE offers that possibility.
Reference
Prasad B, Osman M, Jafari M, et al. Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol. 2022;17(1):17–26.
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