Results:The systematic review confirmed that multimorbidity and frailty were rarely considered or reported in existing kidney failure prognostic model development or validation.Across the quantitative studies, KFRE demonstrated good discrimination but variable calibration in individuals with multimorbidity and frailty, with underestimation in frailty groups and overestimation in those with increasing numbers of long-term conditions.Qualitative findings highlighted that CKD was often deprioritised by both patients and healthcare professionals, with limited awareness of the diagnosis and uncertainty surrounding kidney failure risk and symptom attribution.Although healthcare professionals recognised the potential value of KFRE to support shared decision making, barriers included workload pressures, system integration challenges and difficulties communicating risk in the context of competing health priorities and potential emotional burden of these discussions.Triangulation revealed convergence that frailty and multimorbidity affect both KFRE accuracy and its clinical applicability, complementarity where qualitative data highlighted barriers to implementation, and dissonance where statistical adequacy contrasted with limited real-world use.Conclusion: KFRE remains a valuable prognostic tool but requires contextual adaption for individuals with multimorbidity and frailty.Effective use depends on supportive systems, continuity of care, and communication strategies that acknowledge uncertainty and competing priorities.Future research should focus on approaches to integrate KFRE into person-centred care, explore communication strategies/ frameworks for discussing risk in complex CKD populations and in settings of uncertainty, and comparative studies with models that consider the competing risk of death.I have potential conflict of interest to disclose.
Fitchat et al. (Wed,) studied this question.