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Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Open accessAbstract
BACKGROUND AND OBJECTIVES: Prognostic information is rarely conveyed by nephrologists because of clinical uncertainty about accuracy. The objective of this study was to develop an integrated prognostic model of 6-mo survival for patients who receive hemodialysis (HD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A short-term prognostic model was developed using prospective data from a derivation cohort of 512 patients who were receiving HD at five dialysis clinics. Patient charts were reviewed for actuarial predictors (e.g., Charlson Comorbidity), and nephrologists answered the "surprise" question (SQ), "Would I be surprised if this patient died within the next 6 mo?" Survival was monitored for up to 24 mo. The prognostic model was tested with a validation cohort of 514 patients from eight clinics. RESULTS: In a Cox multivariate analysis of the derivation cohort, five variables were independently associated with early mortality: Older age (hazard ratio [HR] for a 10-yr increase 1.36; 95% confidence interval [CI] 1.17 to 1.57), dementia (HR 2.24; 95% CI 1.11 to 4.48), peripheral vascular disease (HR 1.88; 95% CI 1.24 to 2.84), decreased albumin (HR for a 1-U increase 0.27; 95% CI 0.15 to 0.50), and SQ (HR 2.71; 95% CI 1.76 to 4.17). Area under the curve for the resulting prognostic model predictions of 6-mo mortality were 0.87 (95% CI 0.82 to 0.92) in the derivation cohort and 0.80 (95% CI 0.73 to 0.88) in the validation cohort. CONCLUSIONS: An integrated 6-mo prognostic tool was developed and validated for the HD population. The instrument may be of value for researchers and clinicians to improve end-of-life care by providing more accurate prognostic information.
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Metadata
- Authors
- Cohen, L. M., Ruthazer, R., Moss, A. H., & Germain, M. J.
- Affiliations
- Baystate Medical Center (US)
- Tufts Medical Center (US)
- West Virginia University (US)
- Corresponding author
- Cohen, Lewis M.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2010-01
- Volume
- 5
- Issue
- 1
- Pages
- 72-79
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC2801643
- OpenAlex
- W2116257995
- Cited by
- 391
- References
- 51
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 17 · 2023: 20 · 2022: 17 · 2021: 19 · 2020: 27 · 2019: 25 · 2018: 27 · 2017: 34 · 2016: 33 · 2015: 31 · 2014: 25 · 2013: 35 · 2012: 26
- FWCI
- 14.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- National Institutes of Health (5r21dk076563-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (5 R21 DK076563-02, R21 DK076563)
- 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
- maintenance hemodialysis, 6-month mortality, prognostic model, survival prediction, surprise question, dementia, peripheral vascular disease, serum albumin, age, end-of-life care
- MeSH terms
- Aged, Female, Renal Dialysis, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Time Factors, Models, Statistical, Survival Rate
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