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. 2017 Jul;2(4):645-653.
doi: 10.1016/j.ekir.2017.02.014. Epub 2017 Mar 1.

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

Ling-Xin Chen  1 , Michelle A Josephson  2 , Donald Hedeker  3 , Kellie Hunter Campbell  4 , Nicole Stankus  2 , Milda R Saunders  5
Affiliations

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

Ling-Xin Chen et al. Kidney Int Rep. 2017 Jul.

Abstract

Introduction: Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared to 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 (BMI) <18, the presence of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), immobility, and being institutionalized. Factors associated with increased 5-year survival were non-white race, a primary cause of end stage renal disease (ESRD) other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula (AVF). 5-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).

Conclusion: This clinical prediction score could be useful for physicians to identify potentially suitable candidates for kidney transplantation.

Keywords: USRDS; elderly; kidney transplant referral; mortality; older adults.

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Figures

Figure 1
Figure 1
Flowchart of the study population showing inclusion and exclusion criteria. BMI, body mass index; USRDS, United States Renal Data System.
Figure 2
Figure 2
Kaplan-Meier plot of survival probabilities in the derivation and validation cohorts by the score group.
Figure 3
Figure 3
Box-and-whisker plot of score distributions for each cohort.
Figure 4
Figure 4
Kaplan-Meier plot of survival probabilities of the transplanted cohort from the date of dialysis initiation.
See this image and copyright information in PMC

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