title: Clinical assessment of mortality risk in renal transplant candidates in Spain.
abstract: BACKGROUND
  Prediction of mortality in wait-listed patients for kidney transplantation (KT) has not been well elucidated. We assessed whether application of the Charlson comorbidity index (CCI) and other uremia-related comorbidities, not included in the CCI, were associated with mortality in these patients.
  
  
  METHODS
  We included 3851 adult patients from the Andalusian Registry who were placed on the waiting list for KT during the study period (1984-2012). A total of 1975 patients received a successful KT and were censored at that point, whereas 1876 were on the waiting list at any time. Multivariate Cox proportional regression analysis and competing risk models, both of which included a propensity score for factors leading to KT, were constructed to examine death in wait-listed patients.
  
  
  RESULTS
  Overall mortality on the waiting list was 24%, and cardiovascular disease was the leading cause of death (25%), followed by infections (19%) and malignant disorders (7%). By competing risk models, age older than 50 years (subhazard ratio [SHR] 1.4; 95% CI, 1.1-1.9), CCI score higher than 3 (SHR 2.8; 95% CI, 2.1-3.7), a central venous catheter (SHR 1.8; 95% CI, 1.4-2.2) and unemployed status (SHR 1.7; 95% CI, 1.3-2.2) at dialysis entry were significantly associated with mortality. When these factors were incorporated in a composite risk model, mortality risk increased significantly with increasing risk levels.
  
  
  CONCLUSIONS
  A limited number of comorbidities, easily measurable at entry to dialysis, are associated with mortality in wait-listed patients. This simple clinical assessment may help prioritize high-risk wait-listed patients for receiving an age-matched deceased donor kidney.
authors.affiliation: 1 Nephrology Department, Carlos Haya Regional University Hospital (IBIMA), Málaga, Spain. 2 Transplant Coordinator Center and Andalusian Health Service, Seville, Spain. 3 Biostatistic Unit, Hospital Ramón y Cajal IRYCIS, CIBERESP, Madrid, Spain. 4 Nephrology Department, Hospital General Universitario de Ciudad Real, Spain. 5 Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain. 6 Address correspondence to: Domingo Hernández, M.D., Nephrology Department, Carlos Haya Regional University Hospital. E-29010 Málaga, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.forename: Pablo Castro
authors.initials: PC
authors.lastname: de la Nuez
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Pedro
authors.initials: P
authors.lastname: Ruiz-Esteban
authors.forename: Miguel
authors.initials: M
authors.lastname: González-Molina
authors.forename: Dolores
authors.initials: D
authors.lastname: Burgos
authors.forename: Mercedes
authors.initials: M
authors.lastname: Cabello
authors.forename: Sara
authors.initials: S
authors.lastname: Luengo
authors.forename: Eulalia
authors.initials: E
authors.lastname: Palma
authors.forename: Edisson
authors.initials: E
authors.lastname: Ruda
authors.forename: Elena
authors.initials: E
authors.lastname: Gutiérrez
authors.forename: Carmen
authors.initials: C
authors.lastname: Vozmediano
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
authors.forename: Manuel
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists