Abstract
Introduction 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 <18, the presence of congestive heart failure, chronic obstructive pulmonary disease, immobility, and being institutionalized. Factors associated with increased 5-year survival were non-white race, a primary cause of end-stage renal disease other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula. Five-year mortality was 47% for the lowest risk score group (3.6% of the validation cohort) and >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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 645-653 |
| Number of pages | 9 |
| Journal | Anuario de Psicologia |
| Volume | 47 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2017 |
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Keywords
- elderly
- kidney transplant referral
- mortality
- older adults
- USRDS
ASJC Scopus subject areas
- Psychology(all)
- Psychiatry and Mental health
Cite this
A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation. / Chen, Ling-Xin; Josephson, Michelle A.; Hedeker, Donald; Campbell, Kellie H.; Stankus, Nicole; Saunders, Milda R.
In: Anuario de Psicologia, Vol. 47, No. 1, 01.01.2017, p. 645-653.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation
AU - Chen, Ling-Xin
AU - Josephson, Michelle A.
AU - Hedeker, Donald
AU - Campbell, Kellie H.
AU - Stankus, Nicole
AU - Saunders, Milda R.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Introduction 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 <18, the presence of congestive heart failure, chronic obstructive pulmonary disease, immobility, and being institutionalized. Factors associated with increased 5-year survival were non-white race, a primary cause of end-stage renal disease other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula. Five-year mortality was 47% for the lowest risk score group (3.6% of the validation cohort) and >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.
AB - Introduction 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 <18, the presence of congestive heart failure, chronic obstructive pulmonary disease, immobility, and being institutionalized. Factors associated with increased 5-year survival were non-white race, a primary cause of end-stage renal disease other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula. Five-year mortality was 47% for the lowest risk score group (3.6% of the validation cohort) and >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.
KW - elderly
KW - kidney transplant referral
KW - mortality
KW - older adults
KW - USRDS
UR - http://www.scopus.com/inward/record.url?scp=85027712710&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85027712710&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2017.02.014
DO - 10.1016/j.ekir.2017.02.014
M3 - Article
AN - SCOPUS:85027712710
VL - 47
SP - 645
EP - 653
JO - Anuario de Psicologia
JF - Anuario de Psicologia
SN - 0066-5126
IS - 1
ER -