In 26 229 patients with data for the urine albumin to creatinine ratio, the four variable kidney failure risk equation (KFRE) showed marginal improvement in discrimination over our new equation (C statistic 0.950, 95% CI 0.942 to 0.958 for KFRE <i>v</i> 0.926, 0.915 to 0.936, for the new equation). The gene discussed is ALB; the disease is kidney failure.