title: A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation.
abstract: Patients over the age of 70 constitute the fastest growing segment of the ESKD population worldwide, but most of them are not considered candidates for kidney transplantation (KT). We have developed a simple clinical screening score to identify incident elderly dialysis patients over 70 years with an acceptable long-term prognosis to identify those patients most suitable for KT evaluation. From the French national prospective registry, a logistic regression was used to develop a risk score of mortality within 3 years in a derivation cohort (years 2002-06) and validated in a separate cohort (years 2007-08). Of the 9305 patients in the derivation cohort, the points assigned for the score were: male (1pt); age (75-80); 2pts), (80-85; 5pts), 85 and over (9pts); diabetes (2pts); intermittent hemodialysis (2pt); peripheral vascular disease stage III-IV (5pts); congestive heart failure stages I-II (2pts), III-IV (4pts); dysrhythmia (2pts); chronic respiratory disease (2pts); active malignancy (5pts); severe behavioral disorder (6pts); cardiovascular disease (1pt); mobility (needs assistance for transfers (4pt), totally dependent (9pts)); BMI (21-25; 1pt), BMI (<21; 3pts); and temporary central vascular catheter (3pts). In the 7947 patient validation cohort, the probability of patients being alive within 3 years was around 70% for the lowest risk score quintile (0-6 pts) representing about 20% of incident patients. Thus, our tool identified a subgroup of patients to help nephrologists select individuals who, despite their age, could be suitable candidates for KT evaluation.
authors: Service de Néphrologie-dialyse-transplantation, CHU Nice, Nice, France.
authors: Emmanuelle
authors: E
authors: Dusseux
authors: Service de Néphrologie-dialyse-transplantation, CHU Nice, Nice, France.
authors: Laetitia
authors: L
authors: Albano
authors: Service de Néphrologie-dialyse-transplantation, CHU Nice, Nice, France.
authors: Coraline
authors: C
authors: Fafin
authors: Service de Néphrologie-immunologie Clinique, CHU Nantes, Nantes, France.
authors: Maryvonne
authors: M
authors: Hourmant
authors: Unité CNRS INSERM, Université Nice Sophia Antipolis, Service de Gériatrie, CHU Nice, Nice, France.
authors: Olivier
authors: O
authors: Guérin
authors: REIN Registry, Agence de Biomédecine, REIN, St Denis La Plaine, France.
authors: Cécile
authors: C
authors: Couchoud
authors: 1] Service de Néphrologie-dialyse-transplantation, CHU Nice, Nice, France [2] Département de Santé publique, CHU Nice, Nice, France [3] EA 2415, Biostatistique, Epidémiologie et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier, Montpellier, France.
authors: Olivier
authors: O
authors: Moranne
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications*; D062905:Central Venous Catheters; D002908:Chronic Disease; D003657:Decision Making; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications; D051346:Mobility Limitation; D009369:Neoplasms / Q000150:complications*; D018579:Patient Selection; D012017:Referral and Consultation; D012042:Registries; D006435:Renal Dialysis; D012140:Respiratory Tract Diseases / Q000150:complications; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors