Nephrology Equation Strong evidence Clinical review pending v1.0.0

Kidney Failure Risk Equation (4-variable)

What is the 2- and 5-year risk of kidney failure in CKD G3–G5?

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About this tool

Four-variable equation (age, sex, eGFR, urine ACR) predicting treated kidney failure, with North American and non-North American calibrations.

Intended use

Adults with CKD G3–G5 (eGFR < 60 mL/min/1.73 m²), e.g. to time nephrology referral and planning.

Outcome

Treated kidney failure (dialysis or transplantation)

Time horizon

2 and 5 years

Derivation population

Canadian referred CKD G3–G5 cohorts (derivation 2011); validated in 31 multinational cohorts across 4 continents (2016).

Do not use in

AKI, eGFR ≥ 60 mL/min/1.73 m², kidney transplant recipients.

Limitations

Does not account for the competing risk of death, so risk may be overestimated in older or multimorbid patients.
Non-North American populations need the recalibrated baseline.

Clinical problems

Kidney function and AKI

Evidence

Evidence level

Strong evidence

Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology

Guideline status

KDIGO 2024 CKD guideline recommends validated risk equations such as the KFRE to guide referral and planning.

Geographic applicability

North America (original calibration); recalibrated for other regions.

Validation studies

Multinational validation (Tangri 2016)

721,357 patientsExternal

CKD G3–G5, 31 cohorts

Calibration adequate in North American cohorts; the original equation overestimated risk in some non-North American cohorts, corrected by lowering baseline risk by 32.9% (2 years) and 16.5% (5 years).

Evidence summaries for this tool are awaiting independent clinical review. Statistics are shown only where they could be attributed to a specific publication.

References

Original publicationTangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA 2011;305:1553-1559. Find on PubMed (opens in a new tab)
Validation studyTangri N, Grams ME, Levey AS, et al. Multinational Assessment of Accuracy of Equations for Predicting Risk of Kidney Failure: A Meta-analysis. JAMA 2016;315:164-174. Find on PubMed (opens in a new tab)
Validation studyMajor RW, et al. The Kidney Failure Risk Equation for prediction of end stage renal disease in UK primary care: An external validation and clinical impact projection cohort study. PLoS Med 2019;16:e1002955. Find on PubMed (opens in a new tab)

Version history

Version	Formula	Effective	Reviewer	Changes
v1.0.0	Tangri 4-variable; coefficients per Major 2019 S1 Text; NA and non-NA baselines	2026-10-03	—	Initial implementation with reference test vectors.

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Kidney function equations

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