A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation

Ling-Xin Chen, Michelle A. Josephson, Donald Hedeker, Kellie H. Campbell, Nicole Stankus, Milda R. Saunders

    Research output: Contribution to journalArticle

    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 languageEnglish (US)
    Pages (from-to)645-653
    Number of pages9
    JournalAnuario de Psicologia
    Volume47
    Issue number1
    DOIs
    StatePublished - Jan 1 2017

    Fingerprint

    Kidney Transplantation
    Dialysis
    Referral and Consultation
    Transplants
    Kidney
    Logistic Models
    Mortality
    Life Expectancy
    Information Systems
    Body Mass Index
    Transplantation
    Databases
    Guidelines
    Physicians
    Survival
    Transplant Recipients

    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 journalArticle

    Chen, Ling-Xin ; Josephson, Michelle A. ; Hedeker, Donald ; Campbell, Kellie H. ; Stankus, Nicole ; Saunders, Milda R. / A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation. In: Anuario de Psicologia. 2017 ; Vol. 47, No. 1. pp. 645-653.
    @article{47385a137c794f07bab4654546121830,
    title = "A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation",
    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.",
    keywords = "elderly, kidney transplant referral, mortality, older adults, USRDS",
    author = "Ling-Xin Chen and Josephson, {Michelle A.} and Donald Hedeker and Campbell, {Kellie H.} and Nicole Stankus and Saunders, {Milda R.}",
    year = "2017",
    month = "1",
    day = "1",
    doi = "10.1016/j.ekir.2017.02.014",
    language = "English (US)",
    volume = "47",
    pages = "645--653",
    journal = "Anuario de Psicologia",
    issn = "0066-5126",
    publisher = "Universitat de Barcelona",
    number = "1",

    }

    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 -