In chronic kidney disease (CKD), potential surrogate endpoints for kidney failure were suggested; however, they must have been evaluated to ensure precise, robust, and integrated research, especially among patients with advanced CKD. The objective of the research was to assess the power and predictive ability of alternative kidney failure endpoints in a population with moderate-to-severe CKD. A survey of extensive, multinational longitudinal data from Chronic Kidney Disease Outcomes and Practice Patterns (Chronic Kidney Disease Outcomes and Practice Patterns Study) was conducted. The researchers conducted a trial of patients with mild-to-moderate chronic kidney disease stages III to V in Brazil, France, Germany, and the United States. Composite endpoints included in the study were as follows: achieving an estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2 or eGFR decline of more than 40%, and the occurrence of any one of the individual endpoints. The Cox proportional hazards model was used to evaluate the number of events and prediction accuracy for each endpoint and the overall number of occasions. The research found that almost 3% of patients had an eGFR below 60 mL/min/1.73 m2 at outline entry. KRT events 1,448 occurred in nearly 28% of these individuals (median follow-up, 2.7 years; interquartile range, 1.2-3.0 years). The eGFR 15 mg/min/1.73 m2 endpoint had a better predictive ability in CKD stage 4 patients (n=54) than 40% EGR decline; however, the endpoints were comparable for people with CKD stage III. The quartile of eGFR 15 mL/min/1.73 m2 with 40% eGFR decline had the best predictive ability for predicting KRT, regardless of CKD stage. KRT impacts the number of periods, as well as their power. Variable visit frequency resulted in a variable eGFR measurement rate. The composite endpoint may aid in going through kidney disease progression among those with advanced CKD. By identifying risk factors and treatments for kidney failure, the method might have enhanced the speed at which innovative discoveries were translated into clinical practice.