A move toward using kidney failure risk, rather than a single measurement of kidney function, may help improve patient outcomes and reduce racial disparities in access to kidney transplantation, according to recent study findings presented at the 2025 American Society of Nephrology Kidney Week.
Led by Jennifer L. Bragg-Gresham, MS, PhD, of the University of Michigan Medical School, Ann Arbor, the study examined whether expanding kidney transplant wait-list criteria beyond an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73 m2 or lower could better identify patients who are most likely to progress to kidney failure.
Using data from about 1 million veterans aged 18 and older who had complete eGFR and albuminuria information available in 2022, the researchers calculated each person’s 2-year risk for end-stage kidney disease with the Kidney Failure Risk Equation (KFRE). They used the 25th percentile of that risk as a potential threshold for wait-listing.
Patient characteristics were then compared by whether they met the conventional eGFR criterion (≤20 mL/min/1.73 m2) or the KFRE criterion (>25% risk).
The researchers identified 10,368 veterans with chronic kidney disease (CKD) as being eligible for wait-listing by at least one of the criteria. Sixty percent of veterans met both criteria, and 20% met only one criterion.
Veterans who qualified only by the eGFR criterion were older than those who qualified by KFRE (71 years vs 53 years, respectively). In addition, more men; members of racial and ethnic minority groups, including Hispanic, Black, and Asian patients; and patients with diabetes and/or albuminuria would be wait-listed based on the KFRE criterion alone.
Although death and hospitalization rates were similar in all groups, the group that met both criteria or the KFRE criterion had the highest rates of kidney failure and lower mortality compared with those who only met eGFR criterion.
“Expanding the wait-listing criteria for kidney transplantation to include risk of kidney failure prioritizes individualized approaches to care and could improve outcomes in younger patients with CKD, as well as improve racial parity in access to kidney transplantation,” Dr. Bragg-Gresham said in an American Society of Nephrology press release. “This approach will continue to be studied prospectively and in populations beyond veterans to verify its potential to improve patient outcomes.”
