We recently held a webinar with Dr. Navdeep Tangri, the Canadian nephrologist and medical researcher who developed the Kidney Failure Risk Equation for accurately predicting the risk of progression to renal failure in patients with chronic kidney disease (CKD). Below is an excerpt from his presentation.
Navdeep Tangri, MD, PhD, FRCP(C)
In terms of progressors, care for advanced CKD poses some unique challenges. Not all patients with CKD stage 4 progress [to kidney failure], but some patients with CKD stage 3 progress. So, staging alone based on GFR kind of misses the mark, and we really believe that care should be aligned with advanced CKD. I’m going to show you an example of how this works and where it has financial implications.
“Staging alone based on GFR kind of misses the mark.”
Ontario case study demonstrates substantial cost savings
This is a case study in Ontario, and it’s actually quite relevant across the rest of Canada. So, everyone agrees that patients with CKD stages 3, 4, and 5 are patients that are high risk and are going to progress to kidney failure. A lot of them are going to progress to kidney failure. Now, these patients also develop some other consequences — namely, bone mineral disorders, concerns about nutrition — and they need to know what their treatment options are. So, they need dialysis education. Often, in these types of clinics across Ontario, across Canada, and across the United States, this kind of care is delivered by teams — nurses, dietitians, pharmacists, and nephrologists — and it ends up costing about CAD 1 600. Where if cared by nephrologists alone for a patient who’s at lower risk may only be CAD 300 annually, and care by a PCP alone for a patient who’s at even lower risk may be CAD 200 annually. So, picking out the high risk of progressors from the low risk of progressors is really important, even in this stage 4 pool, as it can lead to substantial cost savings.
Components of an ideal kidney failure risk prediction model
How do we do this? Well, I think in order to do this, we really needed an ideal model — a model that:
- [Has been] developed across the spectrum of patients with chronic kidney disease
- Has electronic ascertainment and reporting
- Can improve discrimination and reclassification beyond the current standard of care
I like to think of GFR as the current standard of care. I think most would agree that up until now, we’ve been delivering care based on GFR. So I think the new model — whichever model we’re proposing, and I’m proposing the Kidney Failure Risk Equation — it really has to show that it’s better. And finally, I think there really has to be externally validated in diverse patient populations. That’s really got to show accuracy not just in one particular type of ethnicity, one particular type of health system. It has to be beyond that. It has to be widely generalizable for it to be usable globally.
See Dr. Tangri’s entire presentation here: Revolutionizing Renal Care with Predictive Analytics for CKD.