title: Predicting first-year mortality in incident dialysis patients with end-stage renal disease - the UREA5 study.
abstract: We aimed to develop a risk prediction model for first-year mortality (FYM) in incident dialysis patients with end-stage renal disease. We retrospectively examined patient comorbidities and biochemistry, prior to dialysis initiation, using a single-center, prospectively maintained database from 2005-2010, and analyzed these variables in relation to FYM. A total of 983 patients were studied. 22% had left ventricular ejection fraction (LVEF) <45%. FYM was 17%, and independent predictors included URate <500 or >600 μmol/l, LVEF <45% (higher odds ratio if <30%), Age >70 years, Arteriopathies (cerebrovascular and/or peripheral-vascular diseases), serum Albumin <30 g/l, and Alkaline phosphatase >80 U/l (p < 0.05, C-statistic 0.74), and these constitute the acronym UREA5. Using linear modeling, risk weightage/integer of 3 was assigned to LVEF <30%, 2 to age >70 years, and 1 to each remaining variable. Cumulative UREA5 scores of ≤ 1, 2, 3, 4, and ≥ 5 were associated with FYM of 6, 8, 22, 31, and 46%, respectively (p < 0.0001). Increasing UREA5 scores were strongly associated with stepwise worsening of FYM after dialysis initiation.
authors.affiliation: Division of Nephrology, University Medicine Cluster, Singapore, Singapore.
authors.forename: Horng-Ruey
authors.initials: HR
authors.lastname: Chua
authors.forename: Titus
authors.initials: T
authors.lastname: Lau
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.forename: Valerie
authors.initials: V
authors.lastname: Ma
authors.forename: Boon-Wee
authors.initials: BW
authors.lastname: Teo
authors.forename: Sabrina
authors.initials: S
authors.lastname: Haroon
authors.forename: Kwan-Loong
authors.initials: KL
authors.lastname: Choy
authors.forename: Yoke-Ching
authors.initials: YC
authors.lastname: Lim
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Chng
authors.forename: Li-Zhen
authors.initials: LZ
authors.lastname: Ong
authors.forename: Tsz-Yeung
authors.initials: TY
authors.lastname: Wong
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D006435:Renal Dialysis; D013997:Time Factors