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
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