title: A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease.
abstract: OBJECTIVE
  The aim of this study was to develop and validate a prognostic score for 6-month mortality in elderly patients starting dialysis for end-stage renal disease.
  
  
  METHODS
  Using data from the French Rein registry, we developed a prognostic score in a training sample of 2500 patients aged 75 years or older who started dialysis between 2002 and 2006, which we validated in a similar sample of 1642 patients. Multivariate logistic regression with 500 bootstrap samples allowed us to select risk factors from 19 demographic and baseline clinical variables.
  
  
  RESULTS
  The overall 6-month mortality was 19%. Age was not associated with early mortality. Nine risk factors were selected and points assigned for the score were as follows: body mass index <18.5 kg/m2 (2 points), diabetes (1), congestive heart failure stages III to IV (2), peripheral vascular disease stages III to IV (2), dysrhythmia (1), active malignancy (1), severe behavioural disorder (2), total dependency for transfers (3) and unplanned dialysis (2). The median score was 2. Mortality rates ranged from 8% in the lowest risk group (0 point) to 70% in the highest risk group (> or =9 points) and 17% in the median group (2 points). Seventeen percent of all deaths occurred after withdrawal from dialysis, ranging from 0% for a score of 0-1 to 15% for a score of 7 or higher.
  
  
  CONCLUSIONS
  This simple clinical score effectively predicts short-term prognosis among elderly patients starting dialysis. It should help to illuminate clinical decision making, but cannot be used to withhold dialysis. It ought to only be used by nephrologists to facilitate the discussion with the patients and their families.
authors.affiliation: REIN Registry, Agence de la biomédecine, 1 Avenue du Stade de France, 93212 Saint Denis La Plaine Cedex, France. cecile.couchoud@biomedecine.fr
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.forename: Michel
authors.initials: M
authors.lastname: Labeeuw
authors.forename: Olivier
authors.initials: O
authors.lastname: Moranne
authors.forename: Vincent
authors.initials: V
authors.lastname: Allot
authors.forename: Vincent
authors.initials: V
authors.lastname: Esnault
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors