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 SystmOne based version of the 4-variable Kidney Failure Risk Equation (KFRE) Calculator protocol.
  2. The Chronic Kidney Disease (CKD) Category Tool template.
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 using the F12 launcher.
  • 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.
Alert
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

InfoThe 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 | The CKD Category Tool is also available


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 each other) 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 SystmOne or launch from the Renal Tools template (which can be found in the calculator page within the PCIT tools template launcher).
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. 

HP current version number: 1.0.0




    • Related Articles

    • Heart failure review not fully completed (HP216)

      Purpose: This protocol will: Ensure that heart failure reviews are fully completed on saving the patient record. What does it actually do? The protocol performs the following functions: When saving the patient record the tool checks to see if any ...

    • Time Limited New Heart Failure needs echo (HP185)

      Purpose: This protocol will: identify patients who are newly diagnosed with heart failure and warn users if they haven't had an echocardiogram What does it actually do? The protocol performs the following functions: Ensures achievement for QOF for ...

    • 034C NHS Health Check

      This folder sits within Primary Care IT - Reporting Group within folder 034 Eligibility. The NHS Health Check eligibility searches are provided to help Practices call and recall patients based on the nationally specified criteria. A separate folder ...

    • 004B Contract Pro QOF

      004B Routine QOF work The 004B Routine QOF work search folder is located within PCIT Reporting Group in 004 Contracts folder. The 004 Routine QOF work folder is divided into 8 main folders (shown in the screenshot below). Throughout this article PCA ...

    • 009 MHRA, NPSA and CAS alerts

      Do you have a reliable process for managing MHRA, NPSA, CAS or other alerts? At Primary Care IT we scope these for you and build searches for you, so you don't have to do this yourself. You can see the current searches on the left. MHRA001-a) On ...