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Kidney Week

Abstract: PO1221

Surprise Question: A Mortality Predictor in Hemodialysis Patients?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Valerio, Patrícia, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal
  • Farinha, Ana, Centro Hospitalar de Setubal EPE, Setubal, Setúbal, Portugal

Surprise question (SQ), used in Palliative Care (PC) and Oncology, has already been tested to assess prognosis in several chronic diseases.
In Portugal, as worldwide, an elderly and fragile hemodialysis (HD) population has been emerging. Tools to screen patients who might benefit from end of life care would be useful.
The present study aims to test SQ mortality prediction value in a Portuguese cohort of HD patients, answered by nephrologists and nurses. The study ran between November 2018 and November 2019.


We design an observational prospective study. All patients on regular HD for more than 3 months were included.
Experienced nephrologists and dialysis nurses, but without PC training, answered SQ at the beginning of the follow-up.
We collected demographic, clinical and analytical data.At the end of follow-up, we analyzed evolution during follow-up and survival status.


We included 194 patients, median age of 69.9 y-o. Median age-adjusted Charlson Comorbidity Index (aCCI) was 6 (5-8).Table 1.
After one year of follow-up 22 (11.3%) patients have died.
Nephrologist and nurse SQ were both good predictors for mortality within one year, with an OR 7.44 (IC95% 2.92-20.74) and 8.47 (IC95% 3.00-30.34) respectively (both with a p-value <0.001).Institutionalization, aCCI, albuminemia and hospital admissions during follow-up also seems to be important predictors.Table 2.
With multivariate analysis, SQ for nephrologists and nurses are no longer statistically significant: OR 1.25 (IC95% 0.31-5.11) and 3.09 (IC95% 0.81-11.86), respectively.


Our results showed that SQ answered by nephrologist and nurse are not good mortality predictors, reflecting this method subjectivity and the lack of PC training.
Probably, SQ should be reserved to professionals with PC training, a profound gap in nephrologists training in Portugal.