{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:05:14Z","timestamp":1784023514934,"version":"3.55.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Kidney Failure Risk Equation (KFRE) is widely used to estimate the risk of kidney replacement therapy (KRT), but evidence in real-world multicenter advanced chronic kidney disease (ACKD) cohorts\u2014particularly among older patients with substantial competing mortality\u2014remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study including adults with ACKD [baseline estimated glomerular filtration rate (eGFR) &amp;lt;20\u00a0ml\/min\/1.73 m2] followed at specialized multidisciplinary clinics in Barcelona and Seville (2017\u20132022). The 2-year 4-variable KFRE (age, sex, eGFR, and urine albumin-to-creatinine ratio) was externally validated for predicting KRT initiation, treating death as a competing event. Discrimination was assessed using time-dependent area under the curve (AUC); calibration was evaluated using decile-based plots and quantitative metrics [calibration-in-the-large (CITL) and Brier score] using Fine\u2013Gray competing risk methods. Clinical utility was explored using decision curve analysis (DCA) and a 20% KFRE threshold in patients aged\u00a0\u226565 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 503 patients were included. During follow-up, 248 patients initiated KRT and 94 died before KRT. The 2-year 4-variable KFRE showed good discrimination [time-dependent AUC 0.82, 95% confidence interval (CI) 0.73\u20130.91], preserved across age strata. Calibration demonstrated appropriate risk ordering across deciles with mild underestimation (CITL\u00a0\u22120.21 by Fine\u2013Gray; Brier score 0.23). In patients aged\u00a0\u226565 years, a KFRE\u00a0\u226520% was strongly associated with KRT initiation in competing risk models (subdistribution hazard ratio 5.92, 95% CI: 4.08\u20138.60). DCA showed positive net benefit across clinically relevant thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a multicenter Spanish ACKD cohort, the 2-year KFRE demonstrated robust discrimination and acceptable calibration. These findings highlight the clinical utility of the KFRE for risk stratification and KRT planning in older patients with ACKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag192","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:35:21Z","timestamp":1781004921000},"source":"Crossref","is-referenced-by-count":0,"title":["Planning of kidney replacement therapy in advanced CKD using the KFRE formula in a Spanish multicenter cohort"],"prefix":"10.1093","volume":"19","author":[{"given":"Alba","family":"Temprado\u00a0Collado","sequence":"first","affiliation":[{"name":"Department of Nephrology, Llerena\u2013Zafra Hospital Complex , Badajoz ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5983-6863","authenticated-orcid":false,"given":"N\u00e9stor","family":"Toapanta","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Research Institute (VHIR), Autonomous University of Barcelona , Passeig de la Vall d\u2019Hebron 119-129, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1318-1552","authenticated-orcid":false,"given":"Mario","family":"Rom\u00e1n\u00a0Cabezas","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Virgen del Roc\u00edo University Hospital, IBiS\/CSIC, University of Seville , Avenida Manuel Siurot s\/n, Seville ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Bedoya","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Research Institute (VHIR), Autonomous University of Barcelona , Passeig de la Vall d\u2019Hebron 119-129, Barcelona 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Hospital, IBiS\/CSIC, University of Seville , Avenida Manuel Siurot s\/n, Seville ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navdeep","family":"Tangri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba , Winnipeg, Manitoba, Canada; Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3621-0766","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9","family":"Soler","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Vall d\u2019Hebron University Hospital, Vall d\u2019Hebron Research Institute (VHIR), Autonomous University of Barcelona , Passeig de la Vall d\u2019Hebron 119-129, Barcelona 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