Major RW, et al. - People with two or more Chronic Kidney Disease Epidemiology Collaboration eGFR values < 60 ml/min/1.73 m² more than 90 days apart and a urine albumin-to-creatinine ratio or protein-to-creatinine ratio measurement between December 1, 2004, and November 1, 2016, were involved in the cohort in order to externally verify the Kidney Failure Risk Equation's (KFRE's) prognostication of end-stage renal disease (ESRD) events in primary care, perform model recalibration whether necessary, and evaluate its projected influence on referral rates to secondary care renal services. In this cohort, in primary care, the recalibrated KFRE correctly prognosticated the risk of ESRD at 2 and 5 years. For referrals to secondary care renal services, adding it into primary care may result in a decrease in unwanted referrals, and earlier referrals in those who go on to develop ESRD.