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Abstract: SA-PO1003

A Clinical Nomogram for the Prediction of Early Mortality in Elderly Patients Initiating Dialysis for ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yoshida, Masaki, Sanshikai TOHO hospital, Midori, Japan
  • Ueki, Kazue, Sanshikai TOHO hospital, Midori, Japan
Background

The number of elderly patients (>80 years) with end-stage renal disease is rapidly increasing. The initiation of dialysis extends the duration of survival; however, the rate of early mortality—mortality within the first few months after the initiation of dialysis—is reportedly higher than the rate of late mortality.

Methods

We retrospectively studied a cohort of 300 patients, aged 80 years or older, in whom dialysis was initiated between January 1, 2010 and December 31, 2017. The rate of early mortality was assessed using the Kaplan-Meier method and the equivalence of survival curves was tested using log-rank tests. The univariate and multivariate analyses were performed using the Cox proportional-hazards model. To evaluate nomogram performance, we assessed both the discrimination and calibration of these models. Two hundred bootstrap resamples were used for internal validation of the accuracy estimates to reduce over-fit bias and to determine 95% confidence intervals

Results

The nomogram was built from eight predictors of initiation of dialysis by the temporary catheter (Hazard Ratio[HR]:1.58, P=0.025), COPD (HR:2.93, P=0.008), Peripheral vascular disease (HR:2.82, P=0.019), Hemiplegia (HR:1.87, P=0.011), Malignancy (HR:5.37, P<0.001), Serum Albumin<3.0g/dl (HR:1.48, P=0.061), Bone fracture by the fall within one year (HR:2.52, P=0.010) and Performance status≧3(HR:1.77, P=0.025). Nomogram to predict 3- , 6- and 12-month survival using eight easily available clinical characteristics. To use the nomogram, locate patient’s variable on the corresponding axis; draw a line to the points axis, sum the points, and draw a line from the total points axis to the 3-, 6- and 12-month survival rate axis.

Conclusion

We developed and validated a nomogram that predict early mortality in elderly patients starting dialysis for end-stage renal disease. Nomogram might help nephrologists make a shared decision with patients and families regarding the initiation of dialysis.