title: A Clinical Risk Prediction Tool for 6-Month Mortality After Dialysis Initiation Among Older Adults.
abstract: BACKGROUND
  Information on an individual's risk for death following dialysis therapy initiation may inform the decision to initiate maintenance dialysis for older adults. We derived and validated a clinical risk prediction tool for all-cause mortality among older adults during the first 6 months of maintenance dialysis treatment.
  
  
  METHODS
  Prediction model using retrospective administrative and clinical data.
  
  
  METHODS
  We linked administrative and clinical data to define a cohort of 2,199 older adults (age ≥ 65 years) in Alberta, Canada, who initiated maintenance dialysis therapy (excluding acute kidney injury) in May 2003 to March 2012.
  Demographics, laboratory data, comorbid conditions, and measures of health system use.
  
  
  RESULTS
  All-cause mortality within 6 months of dialysis therapy initiation.
  
  
  METHODS
  Predicted mortality by logistic regression with 10-fold cross-validation.
  
  
  RESULTS
  375 (17.1%) older adults died within 6 months. We developed a 19-point risk score for 6-month mortality that included age 80 years or older (2 points), glomerular filtration rate of 10 to 14.9mL/min/1.73m2(1 point) or ≥15mL/min/1.73m2(3 points), atrial fibrillation (2 points), lymphoma (5 points), congestive heart failure (2 points), hospitalization in the prior 6 months (2 points), and metastatic cancer (3 points). Model discrimination (C statistic = 0.72) and calibration (Hosmer-Lemeshow χ2=10.36; P=0.2) were reasonable. As examples, a score < 5 equated to <25% of individuals dying in 6 months, whereas a score > 12 predicted that more than half the individuals would die in the first 6 months.
  
  
  CONCLUSIONS
  The tool has not been externally validated; thus, generalizability cannot be assessed.
  
  
  CONCLUSIONS
  We used readily available clinical information to derive and internally validate a 7-variable tool to predict early mortality among older adults after dialysis therapy initiation. Following successful external validation, the tool may be useful as a clinical decision tool to aid decision making for older adults with kidney failure.
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: James P
authors.initials: JP
authors.lastname: Wick
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Tanvir C
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Faris
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: MacRae
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weaver
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. Electronic address: brenda.hemmelgarn@albertahealthservices.ca.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D002423:Cause of Death; D003661:Decision Support Techniques; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007198:Indians, North American; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D016015:Logistic Models; D008223:Lymphoma / Q000453:epidemiology; D008297:Male; D009026:Mortality; D009362:Neoplasm Metastasis; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D014505:Urban Population
keywords: End-stage renal disease (ESRD); chronic kidney failure; decision tool; dialysis initiation; hemodialysis; mortality; older adults; predictive model; risk score; shared decision-making; treatment decisions