Abstract: FR-PO926

An Integrated Prognostic Model for Shared Decision-Making with Patients with Stage 4-5 CKD

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Landry, Daniel L., Baystate Medical Center, Springfield, Massachusetts, United States
  • Cohen, Lewis, Baystate Medical Center, Springfield, Massachusetts, United States
  • Schmidt, Rebecca J., West Virginia University School of Medicine, Morgantown, West Virginia, United States
  • Moss, Alvin H., West Virginia University School of Medicine, Morgantown, West Virginia, United States
  • Nathanson, Brian Harris, OptiStatim, LLC, Longmeadow, Massachusetts, United States
  • Germain, Michael J., Baystate Medical Center, Springfield, Massachusetts, United States
Background

Patients with advanced chronic kidney disease (CKD) have high mortality and often die before needing dialysis. Studies show that prognostic information is important to patients facing the decision to pursue or forgo dialysis. A model that integrates clinical intuition with objective measures to predict 12-month mortality in patients with advanced CKD could help inform decisions.

Methods

In this prospective, observational study, 749 patients with CKD stage 4 or 5 were followed for 2 years. Demographics and laboratory data were collected while providers assessed functional status by the Karnofsky Performance Scale Index (KPSI) and answered a “surprise” question (SQ), “Would you be surprised if your patient died within the next 6 months?” upon each clinic visit.

Results

Mean (SD) age of the cohort was 69.3 (14.6), 50.9% were male, and 83.6% were Caucasian. Mean (SD) Charlson Comorbidity Index score was 5.9 (2.1) and 136 patients (18.2%) had a KPSI score of 50 (“requires considerable assistance and frequent medical care”) or worse. By 12 months, 101 (13.5%) died and 99 (13.2%) initiated dialysis. A logistic regression model was constructed with 3 predictors of mortality. Area under the ROC curve was 0.81 indicating good discrimination.

Conclusion

In this model, advanced age, poor functional status, and the SQ predicted 12-month mortality in advanced CKD patients. The model is being validated and may assist nephrologists in shared decision-making with CKD patients who are choosing between dialysis versus conservative management.

Logistic Regression Model of 12-Month Mortality (n = 736 patients with complete data)
CovariateOdds Ratio; 95% CIP-Value
Surprise Question (SQ) = No;
Baseline Category = Yes
6.63; (3.68, 11.96)<0.001
Age per 10 year increase1.49; (1.21, 1.83)<0.001
Karnofsky Performance Scale Index (KPSI); Baseline Category = 80 to 1001 
● KPSI = 50 to 702.22; (1.24, 3.98)0.008
● KPSI = 10 to 403.15; (1.02, 9.68)0.046

Funding

  • Private Foundation Support