Predicting potential survival benefit of renal transplantation in patients with chronic kidney disease.
BACKGROUND
To facilitate decision-making about treatment options for patients with end-stage renal disease considering kidney transplantation, we sought to develop an index for clinical prediction of risk for death.


METHODS
We derived and validated a multivariable survival model predicting time to death in 169,393 patients with end-stage renal disease who were eligible for transplantation. We modified the model into a simple point-system index.


RESULTS
Deaths occurred in 23.5% of the cohort. Twelve variables independently predicted death: age, race, cause of kidney failure, body mass index, comorbid disease, smoking, employment status, serum albumin level, year of first renal replacement therapy, kidney transplantation, time to transplant wait-listing and time on the wait list. The index separated patients into 26 groups having significantly unique five-year survival, ranging from 97.8% in the lowest-risk group to 24.7% in the highest-risk group. The index score was discriminative, with a concordance probability of 0.746 (95% CI 0.741-0.751). Observed survival in the derivation and validation cohorts was similar for each level of index score in 93.9% of patients.


CONCLUSIONS
Our prognostic index uses commonly available information to predict mortality accurately in patients with end-stage renal disease. This index could provide valuable quantitative data on survival for clinicians and patients to use when deciding whether to pursue transplantation or remain on dialysis.
van Walraven
Carl
C
Faculty of Medicine, University of Ottawa, Ont. carlv@ohri.ca
Austin
Peter C
PC
Knoll
Greg
G
D000367:Age Factors; D015992:Body Mass Index; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D004651:Employment; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009010:Monte Carlo Method; D011379:Prognosis; D044469:Racial Groups; D012044:Regression Analysis; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012709:Serum Albumin; D012907:Smoking; D016019:Survival Analysis; D013997:Time Factors; D014481:United States; D014850:Waiting Lists
D012709:Serum Albumin