SAT-193 CLINICAL AUDIT OF THE VALIDATION OF A MODEL TO PREDICT PROGRESSION OF CHRONIC KIDNEY DISEASE TO END STAGE KIDNEY DISEASE

Abstract

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular events or progression to kidney failure requiring either renal replacement therapy or conservative management. Clinical decision making for CKD is challenging due to disease heterogeneity and variability in rates of progression. Accurate prediction of risk may facilitate individualized decision making, enabling appropriate patient care. There are various instruments for predicting CKD progression. Tangri et al describes four and eight variable equations that predict the 2 and 5-year probability of treated kidney failure (dialysis or transplantation) for patients with CKD stage 3 to 4. Four variable equations use sex, age, eGFR and urine albumin: creatinine. Eight variable equations add serum phosphate, calcium, bicarbonate and albumin. Our audit aims to validate these prognostication models for clinical estimation of 2 and 5-year probability of progression of chronic kidney disease 3/4 to chronic kidney disease stage 5 requiring dialysis or transplant (CKD5D/T) in Australia. We analysed patients referred to the ‘Chronic Kidney Team’ (CKT) clinic; a multidisciplinary comprehensive care service for patients with CKD 3-5 in Metro North Hospital & Health Service. We included patients who were referred to CKT between 2008 and 2012 who subsequently progressed to CKD5D/T up to 2018. We excluded patients who did not have sufficient clinical data for 8-variable progression risk to be calculated. 47 patients had progression of CKD3/4 to CKD5D/T. 30/47 (64%) patients were male. The median age at referral to CKT was 60 years. 34 (72%) patients had CKD stage 4 on referral to the service. 12/34 had low risk of progression to CKD5D/T at 2 years of whom 2/12 progressed to CKD5D/T. 8 patients had predicted high risk of whom 6 progressed as expected to dialysis commencement. 13 (28%) patients had CKD stage 3. 6/13 had low predicted risk of progression at 5 years of whom 4/6 progressed unexpectedly. 1/13 was identified as having high risk at 5 years and that 1 patient progressed to CKD5D/T. 6/18 CKD 3/4 patients with predicted low risk progressed to CKD5D/T unexpectedly. 1/6 had emergency abdominal surgery, 1/6 patient had unexplained rapid progression and 4/6 had acute upper gastro-intestinal haemorrhage causing terminal decline of kidney function. The number of patients analysed was small. The 8-variable equation accurately predicted high risk of progression to CKD5D/T in 7/9 CKD3/4 patients.