Practical recommendations for the implementation of the Kidney Failure Risk Equation in a clinical laboratory setting

The Kidney Failure Risk Equation (KFRE) is a validated tool for predicting the risk of kidney failure in patients with chronic kidney disease (CKD) and is increasingly recommended to guide referral pathways, monitoring, and treatment decisions. As its clinical use expands, laboratories play a central role in ensuring accurate, standardized, and harmonized implementation. However, important methodological questions remain regarding the selection of estimated glomerular filtration rate (eGFR) equations, additional laboratory biomarkers, reporting practices, and analytical considerations, while current guidance remains heterogeneous. This document reviews the available evidence and international guidance on the laboratory implementation of the KFRE, with a particular focus on eGFR equations, creatinine and cystatin C, albuminuria measurement, measured GFR, analytical performance, and reporting considerations. Based on this evidence, the Nephrology Commission of the Spanish Society of Laboratory Medicine (SEMEDLAB) presents consensus recommendations for standardized implementation of the KFRE in routine clinical laboratory practice. By distinguishing the available evidence from expert consensus, this document aims to support harmonized laboratory practice, facilitate consistent KFRE reporting, and promote reliable risk stratification to improve the care of patients with CKD.