A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation

Abstract

Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared with their waitlisted counterparts, but guidelines are not clear about how to identify appropriate transplantation candidates. We developed a clinical prediction score to identify elderly dialysis patients with expected 5-year survival appropriate for kidney transplantation (>5 years). Methods: Incident dialysis patients in 2006–2009 aged ≥70 were identified from the United States Renal Data System database and divided into derivation and validation cohorts. Using the derivation cohort, candidate variables with a significant crude association with 5-year all-cause mortality were included in a multivariable logistic regression model to generate a scoring system. The scoring system was tested in the validation cohort and a cohort of elderly transplant recipients. Results: Characteristics most predictive of 5-year mortality included age >80, body mass index 90% for the highest risk cohort (42% of the validation cohort). Discussion: This clinical prediction score could be useful for physicians to identify potentially suitable candidates for kidney transplantation.

Keywords

• elderly
• kidney transplant referral
• mortality
• older adults
• USRDS