{"id":"15bddfa879bf","type":"article","url":"https://hartvaat.nl/2026/06/30/kfre-aangepast-voor-multimorbiditeit-verbetert-schatting-nierfalenrisico/","title":"KFRE aangepast voor multimorbiditeit verbetert schatting nierfalenrisico","title_en":"The kidney failure risk equation in people with CKD and multimorbidity: the effect of competing mortality risks.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["huisarts","internist"],"tags":[],"journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","doi":"10.1093/ndt/gfaf252","source_url":"https://doi.org/10.1093/ndt/gfaf252","authors":["Heather Walker","Juan-Jesus Carrero","Michael K Sullivan","Ryan Field","Anne-Laure Faucon","Jennifer S Lees","Edouard L Fu","Bhautesh Dinesh Jani","Katie Gallacher","Patrick B Mark"],"significance":6,"published":"2026-08-03","source_date":"2026-06-30","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"A large cohort study using UK Biobank and SCREAM data demonstrates that the standard Kidney Failure Risk Equation (KFRE) underestimates kidney failure risk in chronic kidney disease patients with multimorbidity. An updated model that accounts for competing mortality risks significantly improved calibration (O/E ratio 0.98 versus 1.75 for the original KFRE), while cystatin C-based eGFR did not enhance performance. This refined risk stratification tool offers clinicians a more accurate basis for timing nephrology referral and managing complex multimorbid patients.","created":"2026-07-27T01:14:35Z","updated":"2026-08-10T10:37:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een grote cohortstudie (UK Biobank en SCREAM) bevestigt dat de standaard Kidney Failure Risk Equation (KFRE) het risico op nierfalen onderschat bij patiënten met chronische nierziekte (CKD) en multimorbiditeit. Door een aangepast model te ontwikkelen dat rekening houdt met concurrerend sterfterisico, verbeterde de kalibratie van de risicoschatting aanzienlijk (O/E-ratio 0,98 versus 1,75 bij de standaard KFRE). Deze methodeverbetering biedt klinisch handvatten voor een nauwkeurigere risicoprofilering en timing van nefrologische verwijzing bij complexe patiënten.","abstract_original":"BACKGROUND AND HYPOTHESIS: Guidelines recommend using risk prediction models for predicting kidney failure in chronic kidney disease (CKD). Many people with CKD have multiple long-term conditions (multimorbidity), which influences outcomes including kidney failure and mortality. This study validated the four-variable kidney failure risk equation (KFRE) in individuals with CKD, with and without multimorbidity, comparing performance of KFRE using creatinine and cystatin C to calculate estimated glomerular filtration rate (eGFR) and updated the model to account for competing mortality risks. METHODS: Observational cohort study using research-based (UK Biobank) and population-based cohorts (Stockholm Creatinine Measurements project: SCREAM). Multimorbidity was defined as two or more long-term conditions in addition to CKD. Kidney failure was defined as long-term dialysis or kidney transplantation. KFRE performance assessment included discrimination, calibration, and overall fit at 2 and 5 years. An updated model (using the same variables as KFRE) accounting for competing mortality risks was developed and validated. RESULTS: 14 998 of 24 489 individuals in UK Biobank (61.2%) and 30 147 of 42 902 individuals in SCREAM (70.3%) had multimorbidity. Discrimination of KFRE was good (area under curve $\\ge $0.86 across eGFR equations in all cohorts, multimorbidity groups and time horizons). Kidney failure risk was under-estimated in people with multimorbidity in UK Biobank (observed/expected (O/E) ratio 1.75 at 5 years; eGFR creatinine). Conversely, calibration-in-the-large (O/E ratio) at 5 years in SCREAM was 1.05 in the multimorbidity group (eGFR creatinine). Using cystatin C compared to creatinine did not improve model performance.Cumulative incidence of death was higher with multimorbidity compared to no multimorbidity. An updated model considering competing mortality improved calibration performance over KFRE, O/E ratio 0.98 in multimorbidity group of the validation cohort (UK Biobank) at 5 years. CONCLUSION: Competing mortality risk is important when predicting kidney failure, particularly for people with multimorbidity. An updated model accounting for competing mortality risk, permits improved model performance."}