Kidney Failure Risk Equation (KFRE) and Renal Tools (HP179)

Kidney Failure Risk Equation (KFRE) and Renal Tools (HP179)

Overview/Purpose

This protocol contains 2 tools that can be launched on-demand by using the F12 protocol launcher.

  1. The EMIS based version of the 4-variable Kidney Failure Risk Equation (KFRE) Calculator
  2. The Chronic Kidney Disease (CKD) Category Tool
Its purposes is to improve both the assessment of renal risk and the categorisation of kidney disease within a primary care population.  This supports practices in identifying patients who do and don't need referral to a Renal Specialist team, as well as to help manage and prevent CKD progression by bringing advice close to the clinician.

What does it do?

  • The protocol can be launched at any time and is especially useful when processing lab results.
  • The KFRE calculation takes the eGFR, ACR, Age and Gender and gives a UK validated 5-year risk of their CKD progressing to needing Renal Replacement Therapy.
If the risk of needing Renal Replacement Therapy is 5% or more in the next 5 years then referral to a Nephrologist should be considered. 

Why is it important?

In primary care we handle huge volumes of renal data that can be used to better categorise and manage renal (and so cardiovascular) risk.  These tools help to standardise care, speed up categorisation and risk assessment and offer advice based on the patient's latest results and trends.
  1. The CKD Category Tool takes the eGFR and ACR and codes the correct Filtration/Albuminuria category.
  2. Both tools check the records for patient context, including 
    1. Palliative Care status,
    2. Renal pathology, surgical and nephrectomy codes,
    3. Trends in eGFR,
    4. Counts of out of range results,
    5. Catheter supplies
    6. Haematuria,
    7. Current medications etc.
  3. They give NICE advice on risk, medication options and referral management
  4. They offer users options to:
    1. Order outstanding tests
    2. Code categories
    3. Code KFRE value
    4. Take no action

KFRE CALCULATION TOOL

The 2021 chronic kidney disease (CKD): assessment and management NICE guideline [NG203] 
specifically recommends use of the Kidney Failure Risk Equation to understand risk in CKD.
Traditionally, Chronic Kidney Disease has been hard to categorise and manage in Primary Care, in spite of large numbers of laboratory results being filed every day.  The KFRE was devised as a calculation that summarises Age, Gender, eGFR and ACR into a single risk value that can be used to predict the need for Renal Replacement Therapy in the next 5 years.  

The calculation is complicated:
 

Given that these biological values already exist for many in the clinical system, we have built a calculator for both SystmOne and EMIS that gives an instant and accurate result, without having to use online (or handheld!) calculators.
Using this we can more easily determine who to refer (and importantly who not to) for further renal care. 

CKD CATEGORY TOOL

The CKD Category Tool uses the more traditional method of classification to automatically code a patient's results and advise on management.  Doing this also ensures the patient is on the CKD Register for QOF.

What does it look like?

These screenshots show a examples of both the KFRE CALCULATOR and CKD CATEGORY tools from this Handy Protocol in different use cases.  Please note, the output boxes are highly adaptable and there will be lots of different potential outputs, based on the circumstances of the patient.  Just some of things that influence the outputs include: 
  1. Diabetes, Chronic Kidney Disease, Renal structural disease
  2. Presence or absence of medications : ACE inhibitors / ARB, SGLT2 inhibitors, Statins
  3. Haematuria, Albuminuria, multiple low eGFRs
  4. Palliative care scenarios
  5. … and more

Landing Page | Where the KFRE CAN be calculated with existing data.  The CKD Category Tool is also available

KFRE Landing Page 1

Landing Page | Where the KFRE CANNOT be calculated with existing data.  The CKD Category Tool is available

KFRE Landing Page 2

KFRE CALCULATOR

KFRE Output

CKD CATEGORY TOOL


System Dependencies

All tools rely on up to date blood results (coded eGFR) and an Albumin Creatinine Ratio.
If these tests are nearly simultaneous (ideally within 7 days of eachother) then the KFRE can be calculated. 
A CKD Category can be assigned regardless of the time frame between those tests, but good practice is for them to be recent and also timed together. 

System Triggers

System trigger: Manual Launch from the "F12 Protocol Launcher" in SystmOn
Run mode: N/A
Enable trigger for: N/A

Change management considerations

Your team need to understand when it is appropriate to calculate a KFRE and categorise CKD.  In many cases, knowing a KFRE is not helpful to management.
Training on the NICE NG203 guidelines and where the KFRE fits in with these is advised. 

How to get it

This protocol is automatically installed in your system.  If you are waiting for installation and want us to prioritise your site, please submit a ticket to request this.

HP current version number: 1.0.0



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