title: Development and validation of a predictive mortality risk score from a European hemodialysis cohort.
abstract: Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decision-making, those currently available have limited applicability, robustness, and generalizability. Here we applied a modified Framingham Heart Study approach to derive 1- and 2-year all-cause mortality risk scores using a 11,508 European incident HD patient database (AROii) recruited between 2007 and 2009. This scoring model was validated externally using similar-sized Dialysis Outcomes and Practice Patterns Survey (DOPPS) data. For AROii, the observed 1- and 2-year mortality rates were 13.0 (95% confidence interval (CI; 12.3-13.8)) and 11.2 (10.4-12.1)/100 patient years, respectively. Increasing age, low body mass index, history of cardiovascular disease or cancer, and use of a vascular access catheter during baseline were consistent predictors of mortality. Among baseline laboratory markers, hemoglobin, ferritin, C-reactive protein, serum albumin, and creatinine predicted death within 1 and 2 years. When applied to the DOPPS population, the predictive risk score models were highly discriminatory, and generalizability remained high when restricted by incidence/prevalence and geographic location (C-statistics 0.68-0.79). This new model offers improved predictive power over age/comorbidity-based models and also predicted early mortality (C-statistic 0.71). Our new model delivers a robust and reproducible mortality risk score, based on readily available clinical and laboratory data.
authors: Nephrology, RWTH University of Aachen, Aachen, Germany.
authors: Jürgen
authors: J
authors: Floege
authors: Center for Observational Research (CfOR), Amgen Ltd, Uxbridge, UK.
authors: Iain A
authors: IA
authors: Gillespie
authors: Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Florian
authors: F
authors: Kronenberg
authors: Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany.
authors: Stefan D
authors: SD
authors: Anker
authors: On behalf of Amgen Ltd, Uxbridge, UK.
authors: Ioanna
authors: I
authors: Gioni
authors: Global Biostatistics, Amgen Ltd, Uxbridge, UK.
authors: Sharon
authors: S
authors: Richards
authors: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors: Ronald L
authors: RL
authors: Pisoni
authors: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors: Bruce M
authors: BM
authors: Robinson
authors: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany.
authors: Daniele
authors: D
authors: Marcelli
authors: International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland.
authors: Marc
authors: M
authors: Froissart
authors: Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Kai-Uwe
authors: KU
authors: Eckardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment
references: J Am Soc Nephrol. 2003 Apr;14(4):1012-21
references: 12660336
references: Am J Kidney Dis. 2002 Jul;40(1):82-9
references: 12087565
references: Nephrol Dial Transplant. 2004 Feb;19(2):413-20
references: 14736967
references: Stat Med. 2004 May 30;23(10):1631-60
references: 15122742
references: Am J Kidney Dis. 2004 Nov;44(5 Suppl 2):7-15
references: 15486868
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: Am J Kidney Dis. 2003 Jul;42(1):125-32
references: 12830464
references: JAMA. 2009 Oct 28;302(16):1782-9
references: 19861670
references: Clin J Am Soc Nephrol. 2009 Nov;4(11):1818-26
references: 19808231
references: Kidney Int. 2010 Jan;77(2):141-51
references: 19907414
references: Clin J Am Soc Nephrol. 2010 Jan;5(1):72-9
references: 19965531
references: CMAJ. 2010 Apr 20;182(7):666-72
references: 20351122
references: Am J Kidney Dis. 2011 Jun;57(6):894-902
references: 21489668
references: Nephron Clin Pract. 2011;118(2):c143-54
references: 21150222
references: Clin J Am Soc Nephrol. 2011 Jul;6(7):1651-62
references: 21734085
references: Clin J Am Soc Nephrol. 2011 Nov;6(11):2642-9
references: 21959599
references: PLoS One. 2012;7(4):e36224
references: 22558392
references: Am J Nephrol. 2012;36(2):136-43
references: 22813921
references: Kidney Int. 2013 Jul;84(1):149-57
references: 23515055
references: Lancet. 2013 Jul 13;382(9887):158-69
references: 23727165
references: Nephrol Dial Transplant. 2013 Nov;28(11):2670-7
references: 23975843
references: Epidemiology. 2014 Jan;25(1):114-21
references: 24240655
references: Clin J Am Soc Nephrol. 2014 Mar;9(3):513-9
references: 24311712
references: Am J Kidney Dis. 1994 Jun;23(6):836-45
references: 8203366
references: Stat Med. 1996 Feb 28;15(4):361-87
references: 8668867
references: Lancet. 2005 Jan 22-28;365(9456):331-40
references: 15664230
references: Semin Nephrol. 2005 Nov;25(6):358-62
references: 16298255
references: Semin Nephrol. 2006 Mar;26(2):118-33
references: 16530605
references: Nephrol Dial Transplant. 2006 Apr;21(4):945-56
references: 16339161
references: Nephrol Dial Transplant. 2007 May;22(5):1377-82
references: 17276995
references: Clin J Am Soc Nephrol. 2007 Jan;2(1):89-99
references: 17699392
references: JAMA. 2007 Nov 7;298(17):2038-47
references: 17986697
references: Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
references: 17569110
references: Am J Kidney Dis. 2008 Jul;52(1):111-7
references: 18511166
references: Clin J Am Soc Nephrol. 2008 Sep;3(5):1379-84
references: 18596118
references: Nephrol Dial Transplant. 2009 May;24(5):1553-61
references: 19096087
references: Am J Kidney Dis. 1991 Jan;17(1):25-8
references: 1986566
references: Lancet. 1993 Feb 13;341(8842):415-8
references: 8094182
references: Med Care. 1993 Feb;31(2):141-54
references: 8433577
references: JAMA. 2001 Jul 11;286(2):180-7
references: 11448281
references: Am J Kidney Dis. 2001 Dec;38(6):1251-63
references: 11728958