Pro: Risk scores for chronic kidney disease progression are robust, powerful and ready for implementation.

Accurate risk prediction for chronic kidney disease (CKD) progression can inform the patient-provider dialogue, and provide actionable thresholds for key clinical decisions. In 2011, we developed the kidney failure risk equations (KFREs) to predict the risk of kidney failure requiring dialysis or transplant in patients with CKD. Subsequently, the KFREs have been extensively validated, and have now been proven accurate in multiple continents, ethnicities and disease-specific subpopulations. They can discriminate progressors from non-progressors, and are well calibrated and easy to use. We believe that current and future studies should now focus on clinical implementation of the KFREs, through quality improvement initiatives and cluster randomized trials. A risk-based care paradigm for CKD care can be achieved through knowledge translation and implementation research.