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Cited by 318Dialysis and Renal Disease ManagementPalliative Care and End-of-Life IssuesChronic Kidney Disease and Diabetes

A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease

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Couchoud, C., Labeeuw, M., Moranne, O., Allot, V., Esnault, V., Frimat, L., Stengel, B., for the French Renal Epidemiology and Information Network (REIN) registry·2009·Nephrology Dialysis Transplantation
DOI 10.1093/ndt/gfn698PMC PMC3094349
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Abstract

AIM: The aim of this study was to develop and validate a prognostic score for 6-month mortality in elderly patients starting dialysis for end-stage renal disease. METHODS: Using data from the French Rein registry, we developed a prognostic score in a training sample of 2500 patients aged 75 years or older who started dialysis between 2002 and 2006, which we validated in a similar sample of 1642 patients. Multivariate logistic regression with 500 bootstrap samples allowed us to select risk factors from 19 demographic and baseline clinical variables. RESULTS: The overall 6-month mortality was 19%. Age was not associated with early mortality. Nine risk factors were selected and points assigned for the score were as follows: body mass index <18.5 kg/m2 (2 points), diabetes (1), congestive heart failure stages III to IV (2), peripheral vascular disease stages III to IV (2), dysrhythmia (1), active malignancy (1), severe behavioural disorder (2), total dependency for transfers (3) and unplanned dialysis (2). The median score was 2. Mortality rates ranged from 8% in the lowest risk group (0 point) to 70% in the highest risk group (> or =9 points) and 17% in the median group (2 points). Seventeen percent of all deaths occurred after withdrawal from dialysis, ranging from 0% for a score of 0-1 to 15% for a score of 7 or higher. CONCLUSIONS: This simple clinical score effectively predicts short-term prognosis among elderly patients starting dialysis. It should help to illuminate clinical decision making, but cannot be used to withhold dialysis. It ought to only be used by nephrologists to facilitate the discussion with the patients and their families.

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  1. [26]Rubin D. Multiple imputation for nonreponse in surveys. New York: Wiley; 1987. [Google Scholar]

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Authors
Couchoud, C., Labeeuw, M., Moranne, O., Allot, V., Esnault, V., Frimat, L., Stengel, B., & for the French Renal Epidemiology and Information Network (REIN) registry
Affiliations
  • Agence de la Biomédecine (FR)
  • Hôpital Lyon Sud (FR)
  • Centre Hospitalier Universitaire de Limoges (FR)
  • Centre Hospitalier Universitaire de Nice (FR)
  • Centre Hospitalier Régional et Universitaire de Nancy (FR)
Corresponding author
Couchoud, C.
ORCID
Venue
Nephrology Dialysis Transplantation
Publisher
Oxford University Press (OUP)
Published
2008-12-18
Volume
24
Issue
5
Pages
1553-1561
ISSN
  • 0931-0509 (ISSN-L)
  • 1460-2385
DOI
10.1093/ndt/gfn698
PMC
PMC3094349
OpenAlex
W2080496031
Cited by
318
References
40
Citations by year
2026: 3 · 2025: 7 · 2024: 22 · 2023: 17 · 2022: 15 · 2021: 10 · 2020: 17 · 2019: 27 · 2018: 18 · 2017: 23 · 2016: 28 · 2015: 32 · 2014: 17 · 2013: 27 · 2012: 23
FWCI
8.31
Type
journal article
Language
en
Open access
Locations
  • Nephrology Dialysis Transplantation (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HAL (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
prognostic score, end-stage renal disease, dialysis initiation, elderly patients, 6-month mortality, risk factors, body mass index, diabetes mellitus, congestive heart failure, peripheral vascular disease, cardiac arrhythmias, active malignancy, dependency, clinical decision-making
MeSH terms
Age Factors, Aged, Aged, 80 and over, Female, France, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Prognosis, Registries, Risk Factors, Time Factors, Logistic Models, Kaplan-Meier Estimate

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