title: Predictive Modelling Risk Calculators and the Non Dialysis Pathway.
abstract: This guideline will review the current prediction models and survival/mortality scores available for decision making in patients with advanced kidney disease who are being considered for a non-dialysis treatment pathway. Risk prediction is gaining increasing attention with emerging literature suggesting improved patient outcomes through individualised risk prediction (1). Predictive models help inform the nephrologist and the renal palliative care specialists in their discussions with patients and families about suitability or otherwise of dialysis. Clinical decision making in the care of end stage kidney disease (ESKD) patients on a non-dialysis treatment pathway is currently governed by several observational trials (3). Despite the paucity of evidence based medicine in this field, it is becoming evident that the survival advantages associated with renal replacement therapy in these often elderly patients with multiple co-morbidities and limited functional status may be negated by loss of quality of life (7) (6), further functional decline (5, 8), increased complications and hospitalisations.
authors.affiliation: Depts Renal Medicine and Medicine, St George Hospital and University of NSW, Sydney, NSW.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robins
authors.affiliation: Depts Renal Medicine and Medicine, St George Hospital and University of NSW, Sydney, NSW.
authors.forename: Ivor
authors.initials: I
authors.lastname: Katz