Julien Prouvot1,2, Emilie Pambrun2, Valery Antoine1,3, Cecile Couchoud4,5, Cecile Vigneau6, Sophie Roche7, Maud Francois8, Christophe Mariat9, Daniela Babici10, Camelia Prelipcean2, Olivier Moranne11,12. 1. IDESP, INSERM Université de Montpellier, Montpellier, France. 2. Service Néphrologie-Dialyses-Aphérèses, Hôpital Universitaire de Nîmes, CHU Caremeau, Place du Pr Debré, 30000, Nimes, France. 3. Service de Gériatrie, Hôpital Universitaire de Nîmes, Nimes, France. 4. Registre REIN, Agence de la Biomedecine, Saint-Denis La Plaine, France. 5. CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France. 6. CHU Pontchaillou, Service de Néphrologie-Dialyse-Transplantation, Université Rennes 1, IRSET, Rennes, France. 7. Service de Nephrologie‑Dialyse, CH Macon, Macon, France. 8. Service de Néphrologie-Dialyse-Transplantation, CHU Tours, Tours, France. 9. Service de Néphrologie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Étienne, 42055, Saint-Étienne Cedex 02, France. 10. Service Néphrologie-Dialyse, GHR MSA, Hôpital Emile Muller, Mulhouse, France. 11. IDESP, INSERM Université de Montpellier, Montpellier, France. olivier.moranne@chu-nimes.fr. 12. Service Néphrologie-Dialyses-Aphérèses, Hôpital Universitaire de Nîmes, CHU Caremeau, Place du Pr Debré, 30000, Nimes, France. olivier.moranne@chu-nimes.fr.
Abstract
INTRODUCTION: Chronic kidney disease (CKD) is a disease which is spreading worldwide, especially among older patients. Several prognostic scores have been developed to predict death in older CKD patients, but they have not been validated. We aimed to evaluate the existing risk scores for predicting death before dialysis start, identified via an in-depth review, in a cohort of elderly patients with advanced CKD. METHODS: We performed a review to identify scores predicting death, developed in and applicable to CKD patients. Each score was evaluated with an absolute risk calculation from the patients' baseline characteristics. We used a French prospective multicentre cohort of elderly patients (> 75 years) with advanced CKD [estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m2], recruited from nephrological centres, with a 5-year follow-up. The outcome considered was death before initiating dialysis. Discrimination [area under curve (AUC)], calibration and Brier score were calculated for each score at its time frame. RESULTS: Our review found 6 equations predicting death before dialysis in CKD patients. Four of these (GOLDFARB, BANSAL, GRAMS 2 and 4 years) were evaluated. The validation cohort (Parcours de Soins des Personnes Âgées Parcours de Soins des Personnes Âgées, PSPA) included 573 patients, with a median age of 82 years and a median eGFR of 13 mL/min/1.73 m2. At the end of follow-up, 287 (50%) patients had started dialysis and 238 (41%) patients had died before dialysis. The four equations evaluated showed average discrimination (AUC 0.61-0.70) and, concerning calibration, a global overestimation of the risk of death. DISCUSSION: The available scores predicting death before dialysis showed low performance among older patients with advanced CKD in a French multicentre cohort, indicating the need to upgrade them or develop new scores for this population.
INTRODUCTION: Chronic kidney disease (CKD) is a disease which is spreading worldwide, especially among older patients. Several prognostic scores have been developed to predict death in older CKD patients, but they have not been validated. We aimed to evaluate the existing risk scores for predicting death before dialysis start, identified via an in-depth review, in a cohort of elderly patients with advanced CKD. METHODS: We performed a review to identify scores predicting death, developed in and applicable to CKD patients. Each score was evaluated with an absolute risk calculation from the patients' baseline characteristics. We used a French prospective multicentre cohort of elderly patients (> 75 years) with advanced CKD [estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m2], recruited from nephrological centres, with a 5-year follow-up. The outcome considered was death before initiating dialysis. Discrimination [area under curve (AUC)], calibration and Brier score were calculated for each score at its time frame. RESULTS: Our review found 6 equations predicting death before dialysis in CKD patients. Four of these (GOLDFARB, BANSAL, GRAMS 2 and 4 years) were evaluated. The validation cohort (Parcours de Soins des Personnes Âgées Parcours de Soins des Personnes Âgées, PSPA) included 573 patients, with a median age of 82 years and a median eGFR of 13 mL/min/1.73 m2. At the end of follow-up, 287 (50%) patients had started dialysis and 238 (41%) patients had died before dialysis. The four equations evaluated showed average discrimination (AUC 0.61-0.70) and, concerning calibration, a global overestimation of the risk of death. DISCUSSION: The available scores predicting death before dialysis showed low performance among older patients with advanced CKD in a French multicentre cohort, indicating the need to upgrade them or develop new scores for this population.
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