{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T08:13:21Z","timestamp":1778919201652,"version":"3.51.4"},"reference-count":27,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MRC Centre for Global Infectious Disease Analysis","award":["MR\/X020258\/1"],"award-info":[{"award-number":["MR\/X020258\/1"]}]},{"name":"International Science Partnerships Fund (ISPF) through a grant agreement between Imperial College London and the British Council"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,28]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system, driven by limited nephrology capacity and high rates of unplanned dialysis. The kidney failure risk equation (KFRE) estimates the risk of progression to kidney failure (KF) on age, sex, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the four-variable KFRE for the Thai population and to assess the potential impact of KFRE-guided referral strategies on clinical care and health system performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3\u20135\u2009will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1000 iterations) indicated that approximately 920 KF events by 5 years would be required to achieve the target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences and policy briefs to supplement evidence-based referral strategies and health system planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114382","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T07:55:31Z","timestamp":1778918131000},"page":"e114382","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the kidney failure risk equation and its impact on referral strategies for chronic kidney disease: protocol for a retrospective cohort study using national claims and laboratory data in Thailand"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-6292","authenticated-orcid":false,"given":"Jeerath","family":"Phannajit","sequence":"first","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK"},{"name":"Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Center of Excellence for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chirod","family":"Narkpaichit","sequence":"additional","affiliation":[{"name":"National Health Security Office, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4206-9164","authenticated-orcid":false,"given":"Chaisiri","family":"Angkurawaranon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanchanok","family":"Aramrat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faye","family":"Cleary","sequence":"additional","affiliation":[{"name":"Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupert W","family":"Major","sequence":"additional","affiliation":[{"name":"School of Medical Sciences \u2013 Public Health and Epidemiology Division (SAPPHIRE Group), University of Leicester College of Life Sciences, Leicester, UK"},{"name":"University Hospitals of Leicester NHS Trust, Leicester, England, UK"},{"name":"Leicester, Leicestershire and Rutland Integrated Care Board, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warangkana","family":"Pichaiwong","sequence":"additional","affiliation":[{"name":"Nephrology Division, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirirat","family":"Anutrakulchai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kearkiat","family":"Praditpornsilpa","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo C","family":"Turner","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothea","family":"Nitsch","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"},{"name":"Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"UK Renal Registry, UK Kidney Association, Bristol, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026051600552115000_16.5.e114382.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-024-00820-6"},{"key":"2026051600552115000_16.5.e114382.2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3389\/fmed.2024.1501175","article-title":"Global, regional, and national burden inequality of chronic kidney disease, 1990\u20132021: a systematic analysis for the global burden of disease study 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ISN\u2013Global Kidney Health Atlas: A report by the International Society of Nephrology: An Assessment of Global Kidney Health Care Status focussing on Capacity, Availability, Accessibility, Affordability and Outcomes of Kidney Disease. Brussels, Belgium. International Society of Nephrology 2023. 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Royal Thai Air Force Medical Gazette 2022."},{"key":"2026051600552115000_16.5.e114382.9","doi-asserted-by":"publisher","DOI":"10.1016\/J.KINT.2023.10.018"},{"key":"2026051600552115000_16.5.e114382.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.451"},{"key":"2026051600552115000_16.5.e114382.11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.18202"},{"key":"2026051600552115000_16.5.e114382.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.05.031"},{"key":"2026051600552115000_16.5.e114382.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002955","article-title":"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","volume":"16","author":"Major","year":"2019","journal-title":"PLoS Med"},{"key":"2026051600552115000_16.5.e114382.14","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-69715-3","article-title":"An independent validation of the kidney failure risk equation in an Asian population","volume":"10","author":"Kang","year":"2020","journal-title":"Sci Rep"},{"key":"2026051600552115000_16.5.e114382.15","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2020170"},{"key":"2026051600552115000_16.5.e114382.16","unstructured":"The Nephrology Society of Thailand . 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