#5227 KIDNEY FAILURE RISK EQUATION (KFRE) VS GRAMS SCORE, WHICH ONE PREDICTS BETTER THE INITIATION OF RENAL REPLACEMENT THERAPY?

Abstract

Abstract Background and Aims In patients with Advanced Chronic Kidney Disease (ACKD) stage G4 it is necessary to use prognostic tools to predict the need for Kidney Replacement Therapy (KRT), especially in elderly patients, the most used is the Kidney Failure Risk Equation (KFRE). The Grams Score (GS) predicts the risk of KRT, cardiovascular events and mortality, providing better prediction for the choice of KRT modality but requires more parameters in its equation. Ours objective was compare both KFRE and GS prognostic equations to validate which one better predicts the onset of KRT. Method Descriptive, retrospective study of a cohort of patients older than 65 years with G4 CKD attending for the first time in 2016–2017. Follow-up for 5 years or first clinical event defined as need for KRT (including Conservative Renal Treatment with GFR = <8 ml/min/1.72m2) or death. Variables needed to calculate KFRE and GS were collected, as well as events occurred. Results 271 patients who met the inclusion criteria were analyzed. The clinical characteristics are shown in Table 1. The Grams model showed good discrimination for initiating KRT at 2 and 4 years, AUC 0.84 [95%CI 0.77-0.91] and AUC 0.81 [95%CI 0.75-0.87], respectively. The ROC curves presented by both equations showed good discrimination, AUC 0.82 [95%CI 0.74-0.91] and AUC 0.80 [95%CI 0.74-0.87].When comparing the need for 2-year KRT with both equations, we observed both ROC curves were similar (p = 0.356). Table 2 shows results from logistic regression analysis. For the 2-year KRT event by Grams, patients with a score > = 17.85% were 11.53 [95%CI 5.16-27.78] times more likely to initiate KRT. However, compared to KFRE with a score > = 20.77%, they had 17.53 [95%CI 7.59-40.47] times higher probability of KRT (both p<0.001). When we compared both equations in multivariate analysis only the KFRE was significant (ODR 0.217 (95%CI 0.87-0.54). Conclusion In our population, both prognostic equations showed good discrimination to program initiation of KRT. However, the GS could underestimate this need while the KFRE seems to discriminate it better.