Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Other
    • ASN Publications
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • ASN Publications
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • Kidney Week Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Original ArticlesDialysis
You have accessRestricted Access

Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis

Lewis M. Cohen, Robin Ruthazer, Alvin H. Moss and Michael J. Germain
CJASN January 2010, 5 (1) 72-79; DOI: https://doi.org/10.2215/CJN.03860609
Lewis M. Cohen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robin Ruthazer
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alvin H. Moss
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael J. Germain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    Patient flow diagram for derivation and validation cohorts.

  • Figure 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2.

    Survival across quartiles of predicted risk. The model successfully predicted which patients had worse and better survival over time with patients in quintile 5 (q5)—the highest risk quartile—having the poorest survival and patients in q1—the highest quartile—having the best survival. The survival in q5 was significantly worse than all other quintiles pooled together (log-rank test P < 0.0001).

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1.

    Patient characteristics of screened cohort (n = 512 screened patients), overall and stratified by last known survival status

    CharacteristicAnalysis Cohort (n = 512)Died (n = 123)Alive (n = 389)
    Age (yr; mean ± SD)61 ± 1771 ± 1358 ± 17
    Male gender (% [n/N])55.9 (285/510)56.1 (69/123)55.8 (216/387)
    Race, ethnicity (% [n/N])
        white (versus nonwhite)65.8 (327/497)70.6 (84/119)64.3 (243/378)
        black (versus nonblack)27.2 (135/497)21.8 (26/119)28.8 (109/378)
        Hispanic (versus non-Hispanic)14.7 (73/497)13.4 (16/119)15.1 (57/378)
    Time on HD (mo)n = 435n = 106n = 329
        median (q1 to q3)19 (4 to 39)21 (5 to 43)8 (4 to 37)
        <3 mo (% [n])20.2 (88)17.9 (19)21.0 (69)
    Amputation (% [n/N])9.0 (40/442)8.3 (9/108)9.3 (31/334)
    ESRD cause (% [n])n = 504n = 120n = 384
        other45.2 (228)48.3 (58)44.3 (170)
        diabetic (type 2) nephropathy27.2 (137)27.5 (33)27.1 (104)
        hypertensive nephropathy16.3 (82)19.2 (23)15.4 (59)
        glomerulonephritis5.8 (29)2.5 (3)6.8 (26)
        PKD adult onset (autosomal dominant)3.0 (15)0.8 (1)3.6 (14)
        diabetic (type 1) nephropathy2.6 (13)1.7 (2)2.9 (11)
    • q1 to q3, interquartile range; PKD, polycystic kidney disease.

    • View popup
    Table 2.

    Patient characteristics of derivation cohort, stratified by response to the SQ

    CharacteristicResponse to SQ (Surprised If Died within the Next 6 Mo)Pa
    “No” Response (n = 71)“Yes” Response (n = 379)
    Dialysis unit (% [n])n = 71n = 3790.86
        site 114.1 (10)11.9 (45)
        site 29.9 (7)14.5 (55)
        site 329.6 (21)27.2 (103)
        site 435.2 (25)34.8 (132)
        site 511.3 (8)11.6 (44)
    Age (yr; mean ± SD)69.2 ± 15.059.3 ± 17.1<0.0001
    Male gender (% [n/N])46.5 (33/71)58.7 (222/378)0.06
    Race/ethnicity (% [n/N])
        white (versus nonwhite)78.3 (54/69)62.4 (229/367)0.0113
        Hispanic (versus non-Hispanic)15.9 (11/69)14.2 (52/367)0.70
    Time on HD (mo)n = 65n = 315
        median (q1 to q3)8.2 (2.5 to 40.3)20.5 (5.3 to 39.0)0.0352
        incident, <3 mo (% [n/N])26.2 (17/65)17.1 (54/315)0.09
    Amputation (% [n/N])18.3 (11/60)7.3 (24/330)0.0058
    ESRD cause (% [n])n = 70n = 3730.24
        other42.9 (30)46.1 (172)
        diabetic (type 2) nephropathy28.6 (20)27.3 (102)
        hypertensive nephropathy21.4 (15)14.5 (54)
        glomerulonephritis1.4 (1)6.7 (25)
        PKD adult onset (autosomal dominant)1.4 (1)3.2 (12)
        diabetic (type 1) nephropathy4.3 (3)2.1% (8)
    Albuminn = 71n = 378
        mean ± SD3.5 ± 0.43.9 ± 0.4<0.0001
        low, <3.5 (% [n/N])33.8 (24/71)11.4 (43/378)<0.0001
    CCIn = 71n = 379
        total score (median [q1 to q3])10 (8 to 11)7 (5 to 9)<0.0001
        components (% [n/N])
            AIDS5.9 (3/51)2.2 (6/279)0.13
            congestive heart failure66.7 (40/60)31.3 (96/307)<0.0001
            connective tissue disease9.6 (5/52)7.5 (22/293)0.60
            chronic pulmonary disease34.0 (18/53)13.7 (40/291)0.0003
            cerebrovascular Disease39.3 (22/56)17.3 (52/300)0.0002
            dementia9.8 (5/51)3.6 (10/281)0.0482
            hemiplegia8.2 (4/49)4.6 (13/283)0.30
            leukemia or malignant lymphoma0.0 (0/48)1.1 (3/280)0.47
            myocardial infarction26.9 (14/52)15.8 (46/291)0.06
            ulcer disease2.1 (1/48)4.5 (13/286)0.43
            PVD46.3 (25/54)21.3 (64/300)<0.0001
            diabetes72.2 (39/54)58.2 (189/325)0.06
            liver disease14.0 (7/50)8.9 (25/280)0.26
            cancer (malignant solid tumor)33.3 (17/51)10.8 (29/269)<0.0001
    • ↵a P values are from a t test (age), Wilcoxon rank-sum test (time on HD, CCI score), Fisher exact test (ESRD cause), or a χ2 test (all other variables).

    • View popup
    Table 3.

    Multivariable model of survival in the derivation cohort (n = 449 patients with complete data, 103 died)

    VariableaHR95% CI
    SQ, not surprised versus surprised2.711.75 to 4.17
    Albumin (HR expressed for a 1-U increase)0.270.15 to 0.50
    Age (yr; HR expressed for a 10-yr increase)1.361.17 to 1.57
    PVD, yes versus no1.881.24 to 2.84
    Dementia, yes versus no2.241.11 to 4.48
    • ↵a The age range for model development was 16 to 92; albumin range was 1.7 to 5.0. This model should not be applied to cases with ages or albumin values beyond these ranges. Albumin values <3.0 were recoded to 3.0 and values >4.5 were recoded to 4.5 for the model derivation.

    • View popup
    Table 4.

    Comparison of derivation and validation cohorts

    Characteristic/OutcomeDerivation SampleValidation SamplePa
    Patients screened512514
    Patients with sufficient data to make/test model449427b
    Age (yr; mean ± SD)60 ± 17 (n = 449)63 ± 16 (n = 427)0.06
    Gender (male vs. female; % [n/N])56.7 (254/448)57.4 (245/427)0.84
    Race/ethnicity (% [n/N])
        white versus other64.8 (282/435)76.1 (324/426)0.0003
        Hispanic (versus non-Hispanic)14.3 (62/435)15.7 (67/426)0.54
    Time on HD (mo)n = 379n = 423
        median (q1 to q3)18 (4 to 39)37 (18 to 67)<0.0001
        <3 mo (% [n/N])18.7 (71/379)3.8 (16/421)<0.0001
    SQ, not surprised (% [n/N])15.8 (71/449)13.3 (57/427)0.30
    Albuminn = 449n = 4270.14
        mean ± SD3.8 ± 0.43.9 ± 0.4
        <3.5 (% [n])14.9 (67)14.5 (62)0.87
    PVD (% [n/N])3.3 (15)1.4 (6)0.06
    Dementia (% [n/N])19.6 (88/449)22.0 (94/427)0.38
    6-Mo survival (%; Kaplan-Meier estimate [95% CI])95 (92 to 97)92 (89 to 95)c
    • ↵a P values are from a t test (age), Wilcoxon rank-sum test (time on HD), log-rank test (6-mo estimated survival), or a χ2 test (all other variables). Only cases used in deriving or validating the model were used for these comparisons.

    • ↵b Number of patients who had information on the SQ, albumin, age, dementia, and PVD and had known 6-mo survival status and were included in either creating the model (derivation sample) or validating the model (validation sample).

    • ↵c The validation sample is still being followed.

Additional Files

  • Figures
  • Tables
  • Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis

    Files in this Data Supplement:

    • Press Release
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology
Vol. 5, Issue 1
1 Jan 2010
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Lewis M. Cohen, Robin Ruthazer, Alvin H. Moss, Michael J. Germain
CJASN Jan 2010, 5 (1) 72-79; DOI: 10.2215/CJN.03860609

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Lewis M. Cohen, Robin Ruthazer, Alvin H. Moss, Michael J. Germain
CJASN Jan 2010, 5 (1) 72-79; DOI: 10.2215/CJN.03860609
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

Original Articles

  • Association of Polypharmacy with Kidney Disease Progression in Adults with CKD
  • The Effect of Atrasentan on Kidney and Heart Failure Outcomes by Baseline Albuminuria and Kidney Function
  • Collectin11 and Complement Activation in IgA Nephropathy
Show more Original Articles

Dialysis

  • Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN) Registry
  • Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients
  • Defining Left Ventricular Hypertrophy in Children on Peritoneal Dialysis
Show more Dialysis

Cited By...

  • Multivariable prognostic model for dialysis patients with end stage renal disease: An observational cohort study of Pakistan by external validation
  • Age, Gender and Diabetes as Risk Factors for Early Mortality in Dialysis Patients: A Systematic Review
  • Quality of life in advanced renal disease managed either by haemodialysis or conservative care in older patients
  • Lower Extremity Amputation and Health Care Utilization in the Last Year of Life among Medicare Beneficiaries with ESRD
  • Unique palliative care needs of patients with advanced chronic kidney disease - the scope of the problem and several solutions
  • Dementia, Alzheimers Disease, and Mortality after Hemodialysis Initiation
  • Nephrology Provider Prognostic Perceptions and Care Delivered to Older Adults with Advanced Kidney Disease
  • Frailty Screening Tools for Elderly Patients Incident to Dialysis
  • Time to Improve Informed Consent for Dialysis: An International Perspective
  • Serious Illness Conversations in ESRD
  • Dementia and Alzheimer's Disease among Older Kidney Transplant Recipients
  • The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis
  • How long do patients with chronic disease expect to live? A systematic review of the literature
  • Conservative Management and End-of-Life Care in an Australian Cohort with ESRD
  • Supportive Care: Time to Change Our Prognostic Tools and Their Use in CKD
  • Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD--A Systematic Review
  • How I treat acute myeloid leukemia presenting with preexisting comorbidities
  • Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis
  • The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms
  • Caring for Older Patients on Peritoneal Dialysis at End of Life
  • Predicting palliative care needs and mortality in end stage renal disease: use of an at-risk register
  • Four Plus Forty-Four: Hours to Modify, Theirs to Enjoy
  • A Palliative Approach to Dialysis Care: A Patient-Centered Transition to the End of Life
  • A Communication Framework for Dialysis Decision-Making for Frail Elderly Patients
  • The Ethics of Offering Dialysis for AKI to the Older Patient: Time to Re-Evaluate?
  • A Patient-Centered Vision of Care for ESRD: Dialysis as a Bridging Treatment or as a Final Destination?
  • Prognosis and management of chronic kidney disease (CKD) at the end of life
  • Dying on Dialysis: The Case for a Dignified Withdrawal
  • Five Policies to Promote Palliative Care for Patients with ESRD
  • What Determines Whether a Patient Initiates Chronic Renal Replacement Therapy?
  • Conservative care for end-stage kidney disease: joint medical conference with the Renal Association, British Geriatrics Society and Association for Palliative Medicine
  • Can the impact of an acute hospital end-of-life care tool on care and symptom burden be measured contemporaneously?
  • Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology
  • Predicting 12-Month Mortality for Peritoneal Dialysis Patients Using the "Surprise" Question
  • The Ethics of End-of-Life Care for Patients with ESRD
  • Advance Care Planning in CKD/ESRD: An Evolving Process
  • Renal Replacement Therapy in the Elderly Population
  • Informing Our Elders About Dialysis: Is an Age-Attuned Approach Warranted?
  • Ethical Principles and Processes Guiding Dialysis Decision-Making
  • End-of-Life Care Preferences and Needs: Perceptions of Patients with Chronic Kidney Disease
  • Google Scholar

Similar Articles

Related Articles

  • PubMed
  • Google Scholar

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe to ASN Journals

© 2022 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire