BACKGROUND AND OBJECTIVES: Prognostic information is rarely conveyed by nephrologists because of clinical uncertainty about accuracy. The objective of this study was to develop an integrated prognostic model of 6-mo survival for patients who receive hemodialysis (HD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A short-term prognostic model was developed using prospective data from a derivation cohort of 512 patients who were receiving HD at five dialysis clinics. Patient charts were reviewed for actuarial predictors (e.g., Charlson Comorbidity), and nephrologists answered the "surprise" question (SQ), "Would I be surprised if this patient died within the next 6 mo?" Survival was monitored for up to 24 mo. The prognostic model was tested with a validation cohort of 514 patients from eight clinics. RESULTS: In a Cox multivariate analysis of the derivation cohort, five variables were independently associated with early mortality: Older age (hazard ratio [HR] for a 10-yr increase 1.36; 95% confidence interval [CI] 1.17 to 1.57), dementia (HR 2.24; 95% CI 1.11 to 4.48), peripheral vascular disease (HR 1.88; 95% CI 1.24 to 2.84), decreased albumin (HR for a 1-U increase 0.27; 95% CI 0.15 to 0.50), and SQ (HR 2.71; 95% CI 1.76 to 4.17). Area under the curve for the resulting prognostic model predictions of 6-mo mortality were 0.87 (95% CI 0.82 to 0.92) in the derivation cohort and 0.80 (95% CI 0.73 to 0.88) in the validation cohort. CONCLUSIONS: An integrated 6-mo prognostic tool was developed and validated for the HD population. The instrument may be of value for researchers and clinicians to improve end-of-life care by providing more accurate prognostic information.
BACKGROUND AND OBJECTIVES: Prognostic information is rarely conveyed by nephrologists because of clinical uncertainty about accuracy. The objective of this study was to develop an integrated prognostic model of 6-mo survival for patients who receive hemodialysis (HD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A short-term prognostic model was developed using prospective data from a derivation cohort of 512 patients who were receiving HD at five dialysis clinics. Patient charts were reviewed for actuarial predictors (e.g., Charlson Comorbidity), and nephrologists answered the "surprise" question (SQ), "Would I be surprised if this patient died within the next 6 mo?" Survival was monitored for up to 24 mo. The prognostic model was tested with a validation cohort of 514 patients from eight clinics. RESULTS: In a Cox multivariate analysis of the derivation cohort, five variables were independently associated with early mortality: Older age (hazard ratio [HR] for a 10-yr increase 1.36; 95% confidence interval [CI] 1.17 to 1.57), dementia (HR 2.24; 95% CI 1.11 to 4.48), peripheral vascular disease (HR 1.88; 95% CI 1.24 to 2.84), decreased albumin (HR for a 1-U increase 0.27; 95% CI 0.15 to 0.50), and SQ (HR 2.71; 95% CI 1.76 to 4.17). Area under the curve for the resulting prognostic model predictions of 6-mo mortality were 0.87 (95% CI 0.82 to 0.92) in the derivation cohort and 0.80 (95% CI 0.73 to 0.88) in the validation cohort. CONCLUSIONS: An integrated 6-mo prognostic tool was developed and validated for the HD population. The instrument may be of value for researchers and clinicians to improve end-of-life care by providing more accurate prognostic information.
Authors: B J Barrett; P S Parfrey; J Morgan; P Barré; A Fine; M B Goldstein; S P Handa; K K Jindal; C M Kjellstrand; A Levin; H Mandin; N Muirhead; R M Richardson Journal: Am J Kidney Dis Date: 1997-02 Impact factor: 8.860
Authors: Colin C Geddes; Paul C W van Dijk; Stephen McArthur; Wendy Metcalfe; Kitty J Jager; Aeilko H Zwinderman; Michael Mooney; Jonathan G Fox; Keith Simpson Journal: Nephrol Dial Transplant Date: 2005-12-08 Impact factor: 5.992
Authors: Paul K J Han; Minjung Lee; Bryce B Reeve; Angela B Mariotto; Zhuoqiao Wang; Ron D Hays; K Robin Yabroff; Marie Topor; Eric J Feuer Journal: J Pain Symptom Manage Date: 2011-11-08 Impact factor: 3.612
Authors: Rachael L Morton; Angela C Webster; Kevin McGeechan; Kirsten Howard; Fliss E M Murtagh; Nicholas A Gray; Peter G Kerr; Michael J Germain; Paul Snelling Journal: Clin J Am Soc Nephrol Date: 2016-10-03 Impact factor: 8.237