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

    Keywords

    • elderly
    • kidney transplant referral
    • mortality
    • older adults
    • USRDS

    ASJC Scopus subject areas

    • Psychology(all)
    • Psychiatry and Mental health

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