Kidney Failure Risk Calculator

Kidney Failure Risk Equation (KFRE)

The Kidney Failure Risk Equation estimates the probability that a patient with chronic kidney disease (CKD) stages 3 to 5 will progress to treated kidney failure (dialysis or transplant) within five years. The 8-variable version adds serum albumin, bicarbonate, calcium, and phosphorus to age, sex, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (ACR) for improved accuracy in advanced CKD.

How the Point System Works

This calculator follows the point-based KFRE approach: each clinical variable maps to a score, and the total points convert to a 5-year failure probability using a published lookup table. Lower total scores indicate higher risk. For example, heavy proteinuria and very low eGFR contribute large negative point values, pushing the total toward higher predicted failure rates.

To compute ACR from spot urine values, use the Albumin Creatinine Ratio Calculator. For dialysis adequacy after treatment begins, see the Kt/V Calculator.

Interpreting 5-Year Risk

Risk thresholds guide nephrology referral timing and planning for renal replacement therapy. A 5-year probability below 5% generally supports routine monitoring. Values from 5% to 15% suggest closer follow-up and possible nephrology consultation. Probabilities above 15% warrant specialist referral and discussion of dialysis or transplant options. These cutoffs are guides; individual patient context always matters.

Clinical Context

KFRE was developed and validated in large CKD cohorts and performs best when eGFR is below 60 mL/min/1.73 m² and ACR is available. It does not replace clinical judgment, address acute kidney injury, or predict cardiovascular outcomes. Always confirm lab units (mg/g for ACR, g/dL for albumin, mEq/L for bicarbonate) before applying results.