{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:08:42Z","timestamp":1793261322436,"version":"4.5.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n Background:<\/jats:title>\n Predicting allograft failure in kidney transplant recipients can help plan renal replacement therapy and guide patient-provider communication. The kidney failure risk equation (KFRE) accurately predicts the need for dialysis in patients with chronic kidney disease (CKD), but has not been validated in kidney transplant recipients.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n We sought to validate the 4-variable KFRE (age, sex, estimated glomerular filtration rate [eGFR], and urine albumin-to-creatinine ratio [ACR]) for prediction of 2- and 5-year death-censored allograft failure.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Four independent North American Cohorts from Ontario, Canada; Alberta, Canada; Manitoba, Canada; and Wisconsin, United States, between January 1999 and December 2017.<\/jats:p>\n <\/jats:sec>\n \n Patients:<\/jats:title>\n Adult kidney transplant patients at 1-year posttransplantation.<\/jats:p>\n <\/jats:sec>\n \n Measurements:<\/jats:title>\n Kidney failure risk as measured by the KFRE (eGFR, urine ACR, age, and sex).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We included all adult patients who had at least 1 serum creatinine and at least 1 urine ACR measurement approximately 1 year following kidney transplantation. The performance of the KFRE was evaluated using the area under the receiver operating characteristic curve (C-statistic). C-statistics from the 4 cohorts were meta-analyzed using random-effects models.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 3659 patients were included. Pooled C-statistics were good in the entire population, at 0.81 (95% confidence interval: 0.72-0.91) for the 2-year KFRE and 0.73 (0.67-0.80) for the 5-year KFRE. Discrimination improved among patients with poorer kidney function (eGFR < 45 mL\/min\/1.73 m\n 2<\/jats:sup>\n ), with a C-statistic of 0.88 (0.78-0.98) for the 2-year KFRE and 0.83 (0.74-0.91) for the 5-year KFRE.\n <\/jats:p>\n <\/jats:sec>\n \n Limitations:<\/jats:title>\n The KFRE does not predict episodes of acute rejection and there was heterogeneity between cohorts.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The KFRE accurately predicts kidney failure in kidney transplant recipients at 1-year posttransplantation. Further validation in larger cohorts with longer follow-up times can strengthen the case for clinical implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/2054358120922627","type":"journal-article","created":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T08:12:56Z","timestamp":1590394376000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["Validation of the Kidney Failure Risk Equation in Kidney Transplant Recipients"],"prefix":"10.1177","volume":"7","author":[{"given":"Navdeep","family":"Tangri","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Seven Oaks Hospital Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1058-943X","authenticated-orcid":false,"given":"Thomas W.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Seven Oaks Hospital Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"Eng","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Seven Oaks Hospital Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Nash","sequence":"additional","affiliation":[{"name":"Keenan Research Centre for Biomedical Science, St. Michael\u2019s Hospital, University of Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad C.","family":"Astor","sequence":"additional","affiliation":[{"name":"Population Health Sciences, University of Wisconsin\u2013Madison, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngan N.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Im","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7046-0358","authenticated-orcid":false,"given":"Reid","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Seven Oaks Hospital Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren A.","family":"Yuen","sequence":"additional","affiliation":[{"name":"Keenan Research Centre for Biomedical Science, St. Michael\u2019s Hospital, University of Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,5,25]]},"reference":[{"key":"bibr1-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.483"},{"key":"bibr2-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412303"},{"key":"bibr3-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1996.307"},{"key":"bibr4-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001307"},{"key":"bibr5-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.451"},{"key":"bibr6-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.18202"},{"key":"bibr7-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2016.04.002"},{"key":"bibr8-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1159\/000351648"},{"key":"bibr9-2054358120922627","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"bibr10-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1802"},{"key":"bibr11-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"bibr12-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-7161(03)23001-7"},{"key":"bibr13-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.135111"},{"key":"bibr14-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"bibr15-2054358120922627","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"bibr16-2054358120922627","unstructured":"The 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