The Kidney Failure Risk Equation (KFRE)

The Kidney Failure Risk Equation (KFRE) is recommended by NICE to guide personalised care for people with CKD stages 3a-5, including decisions about referral to secondary care. It estimates the risk of progression to kidney failure over the next 2 and 5 years.

Use the UK re-calibrated KFRE tool.

It uses four variables:

1. Age
2. Sex
3. Estimated glomerular filtration rate (eGFR)
4. Urine albumin:creatinine ratio (ACR)

The KFRE can be used to:

• Guide personalised care for people with CKD stages 3a-5.
• Estimate the risk of kidney failure over the next 2 and 5 years. Five-year predictions may be used in primary care to support discussions about referral to secondary care.
• Identify people at higher risk of kidney failure.
  • If the 5-year risk of kidney failure is >5%, referral should be considered, taking into account the person’s wishes and comorbidities.
  • This threshold has replaced the previous recommendation to consider referral when eGFR is <30 mL/min/1.73 m², as it is likely to be more sensitive and specific for predicting the need for kidney replacement therapy (KRT), reducing unnecessary referrals.