The 4-variable KFRE was derived in adults with CKD stages 3–5 referred to nephrology clinics and predicts the 2- and 5-year risk of treated kidney failure (dialysis or transplant) from age, sex, eGFR and urine ACR. It has been externally validated in large multinational cohorts with C-statistics around 0.88–0.91 for 2–5 year kidney failure risk.

Current international guidance (including KDIGO 2024 and NICE NG203) recommends using KFRE alongside eGFR and albuminuria to guide nephrology referral, multidisciplinary CKD care and dialysis access planning. Typical referral thresholds are 5-year KFRE risk ≥3–5%, with higher thresholds (such as ≥15%) used for advance care planning and access creation. Calibration can differ between populations, particularly at higher eGFR or in older adults, and some health systems locally recalibrate the model.

CKD setting	Time horizon	Suggested KFRE risk bands
Stage 3 (derivation paper)	5-year	Low 0–4.9%, intermediate 5.0–14.9%, high ≥15%
Stage 4 (derivation paper)	2-year	Low 0–9.9%, intermediate 10.0–19.9%, high ≥20%

Primary evidence: JAMA 2011 derivation study; JAMA 2016 multinational validation.

Kidney Failure Risk Equation