Article Figures & Data
Figures
- Figure 1.
Patient flow diagram for derivation and validation cohorts.
- 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
- Table 1.
Patient characteristics of screened cohort (n = 512 screened patients), overall and stratified by last known survival status
Characteristic Analysis Cohort (n = 512) Died (n = 123) Alive (n = 389) Age (yr; mean ± SD) 61 ± 17 71 ± 13 58 ± 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 = 435 n = 106 n = 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 = 504 n = 120 n = 384 other 45.2 (228) 48.3 (58) 44.3 (170) diabetic (type 2) nephropathy 27.2 (137) 27.5 (33) 27.1 (104) hypertensive nephropathy 16.3 (82) 19.2 (23) 15.4 (59) glomerulonephritis 5.8 (29) 2.5 (3) 6.8 (26) PKD adult onset (autosomal dominant) 3.0 (15) 0.8 (1) 3.6 (14) diabetic (type 1) nephropathy 2.6 (13) 1.7 (2) 2.9 (11) q1 to q3, interquartile range; PKD, polycystic kidney disease.
Characteristic Response to SQ (Surprised If Died within the Next 6 Mo) Pa “No” Response (n = 71) “Yes” Response (n = 379) Dialysis unit (% [n]) n = 71 n = 379 0.86 site 1 14.1 (10) 11.9 (45) site 2 9.9 (7) 14.5 (55) site 3 29.6 (21) 27.2 (103) site 4 35.2 (25) 34.8 (132) site 5 11.3 (8) 11.6 (44) Age (yr; mean ± SD) 69.2 ± 15.0 59.3 ± 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 = 65 n = 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 = 70 n = 373 0.24 other 42.9 (30) 46.1 (172) diabetic (type 2) nephropathy 28.6 (20) 27.3 (102) hypertensive nephropathy 21.4 (15) 14.5 (54) glomerulonephritis 1.4 (1) 6.7 (25) PKD adult onset (autosomal dominant) 1.4 (1) 3.2 (12) diabetic (type 1) nephropathy 4.3 (3) 2.1% (8) Albumin n = 71 n = 378 mean ± SD 3.5 ± 0.4 3.9 ± 0.4 <0.0001 low, <3.5 (% [n/N]) 33.8 (24/71) 11.4 (43/378) <0.0001 CCI n = 71 n = 379 total score (median [q1 to q3]) 10 (8 to 11) 7 (5 to 9) <0.0001 components (% [n/N]) AIDS 5.9 (3/51) 2.2 (6/279) 0.13 congestive heart failure 66.7 (40/60) 31.3 (96/307) <0.0001 connective tissue disease 9.6 (5/52) 7.5 (22/293) 0.60 chronic pulmonary disease 34.0 (18/53) 13.7 (40/291) 0.0003 cerebrovascular Disease 39.3 (22/56) 17.3 (52/300) 0.0002 dementia 9.8 (5/51) 3.6 (10/281) 0.0482 hemiplegia 8.2 (4/49) 4.6 (13/283) 0.30 leukemia or malignant lymphoma 0.0 (0/48) 1.1 (3/280) 0.47 myocardial infarction 26.9 (14/52) 15.8 (46/291) 0.06 ulcer disease 2.1 (1/48) 4.5 (13/286) 0.43 PVD 46.3 (25/54) 21.3 (64/300) <0.0001 diabetes 72.2 (39/54) 58.2 (189/325) 0.06 liver disease 14.0 (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).
- Table 3.
Multivariable model of survival in the derivation cohort (n = 449 patients with complete data, 103 died)
Variablea HR 95% CI SQ, not surprised versus surprised 2.71 1.75 to 4.17 Albumin (HR expressed for a 1-U increase) 0.27 0.15 to 0.50 Age (yr; HR expressed for a 10-yr increase) 1.36 1.17 to 1.57 PVD, yes versus no 1.88 1.24 to 2.84 Dementia, yes versus no 2.24 1.11 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.
Characteristic/Outcome Derivation Sample Validation Sample Pa Patients screened 512 514 Patients with sufficient data to make/test model 449 427b 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 other 64.8 (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 = 379 n = 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 Albumin n = 449 n = 427 0.14 mean ± SD 3.8 ± 0.4 3.9 ± 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.
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Files in this Data Supplement:
In this issue
Predicting Six-Month Mortality for Patients Who Are on Maintenance Hemodialysis
Jump to section
More in this TOC Section
Original Articles
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