Kidney & Blood Pressure Research (Dec 2019)

Predicting 6-Month Mortality in Incident Elderly Dialysis Patients: A Simple Prognostic Score

  • Josefina Santos,
  • Pedro Oliveira,
  • Jorge Malheiro,
  • Andreia Campos,
  • Sofia Correia,
  • António Cabrita,
  • Luísa Lobato,
  • Isabel Fonseca

DOI
https://doi.org/10.1159/000504136

Abstract

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Aim: Mortality in end-stage renal disease (ESRD) remains high, particularly among elderly, who represents the most rapidly growing segment of the ESRD population in wealthier countries. We developed and validated a risk score in elderly patients to predict 6-month mortality after dialysis initiation. Methods: We used data from a cohort of 421 patients, aged 65 years and over who started dialysis between 2009 and 2016, in our Nephrology department. The predictive score was developed using a multivariable logistic regression analysis. A bootstrapping technique was used for internal validation. Results: The overall mortality within 6 months was 14.0%. Five independent predictors were identified, and a points system was constructed: age 75 years or older (2 points), coronary artery disease (2), cerebrovascular disease with hemiplegia (2), time of nephrology care before dialysis (<3.0 months [2]; ≥3 to <12 months [1]), and serum albumin levels (3.0–3.49 g/dL [1]; <3.0 g/dL [2]). A score of 6 identified patients with a 70% risk of 6-month mortality. Model performance was good in both discrimination (area under the curve of 0.793; [95% CI 0.73–0.86]) and validation (concordance statistics of 0.791 [95% CI 0.73–0.85]). Conclusions: We developed a simple prediction score based on readily available clinical and laboratory data that can be a practical and useful tool to assess short-term prognosis in elderly patients starting dialysis. It may help to inform patients and their families about ESRD treatment options and provide a more patient-centered overall approach to care.

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