Bjorg Thorsteinsdottir1,2,3,4, LaTonya J Hickson4,5, Rachel Giblon3,6, Atieh Pajouhi1, Natalie Connell2, Megan Branda3,7, Amrit K Vasdev1, Rozalina G McCoy1,4, Ladan Zand5, Navdeep Tangri8,9, Nilay D Shah3,6. 1. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America. 2. Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, United States of America. 3. Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America. 4. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America. 5. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America. 6. Division of Health Care Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America. 7. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States of America. 8. Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada. 9. Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada.
Abstract
RATIONAL AND OBJECTIVE: Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. STUDY DESIGN: Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. SETTING & PARTICIPANTS: Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. ESTABLISHED PREDICTORS: Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality. RESULTS: In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. LIMITATIONS: Small sample size, use of secondary data, need for imputation, homogeneous population. CONCLUSION: Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.
RATIONAL AND OBJECTIVE: Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. STUDY DESIGN: Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. SETTING & PARTICIPANTS: Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. ESTABLISHED PREDICTORS: Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality. RESULTS: In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. LIMITATIONS: Small sample size, use of secondary data, need for imputation, homogeneous population. CONCLUSION: Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.
Authors: Sara A Combs; Stacey Culp; Daniel D Matlock; Jean S Kutner; Jean L Holley; Alvin H Moss Journal: Am J Kidney Dis Date: 2014-09-20 Impact factor: 8.860
Authors: James P Wick; Tanvir C Turin; Peter D Faris; Jennifer M MacRae; Robert G Weaver; Marcello Tonelli; Braden J Manns; Brenda R Hemmelgarn Journal: Am J Kidney Dis Date: 2016-11-14 Impact factor: 8.860
Authors: Noel Engels; Gretchen N de Graav; Paul van der Nat; Marinus van den Dorpel; Anne M Stiggelbout; Willem Jan Bos Journal: BMJ Open Date: 2022-09-21 Impact factor: 3.006