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Kidney Week

Abstract: PO0825

Validation of the Surprise Question in an Ethnically Diverse Population to Identify Seriously Ill Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Moss, Alvin H., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Harbert, Glenda, The George Washington University School of Nursing, Ashburn, Virginia, United States
  • Aldous, Annette, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, United States
  • Nicklas, Amanda C., The George Washington University School of Nursing, Ashburn, Virginia, United States
  • Lupu, Dale, The George Washington University School of Nursing, Ashburn, Virginia, United States

Use of the surprise question (SQ)—Would I be surprised if this patient died in the next six months?—to estimate prognosis for dialysis patients has been largely studied in dialysis centers in central Massachusetts and West Virginia. Researchers have called for its value to be confirmed in more ethnically diverse dialysis settings. We tested the effectiveness of the SQ in three urban areas to identify seriously ill dialysis patients (SI) who could potentially benefit from being prioritized for goals of care discussions.


We recruited 10 dialysis centers (6 in NYC, 3 in Denver, CO, and 1 in Dallas, TX) with 1,507 patients. Dialysis staff screened patients monthly for 14 months (May 2019-June 2020) with the SQ to identify those who were SI and recorded outcomes including the number screened and number SI. In this rolling population of patients, we calculated the mortality risk per month of follow-up for SI and not SI and determined the relative risk of death for SI compared to not SI. In addition, after 14 months, the dialysis centers reported the vital status for an initial cohort of 266 SI identified in May 2019.


Over the 14 months, dialysis centers screened a monthly average of 1,342/1,507 (89.1%) and identified 274 (18.2%) as SI. A total of 269 patients died, 134 (49.8%) SI and 135 (50.2%) not SI. The annualized mortality risk was 41.9% for SI and 9.4% for not SI (risk ratio 4.47, 95% CI, 3.49-5.72). For the 266 SI patients identified in May 2019, race included White 153 (57.5%), Black 68 (25.6%), Asian 20 (7.5%), and Other 25 (9.4%); 81 (30.5%) were identified as Hispanic. Vital status was known after 14 months for 231/266 (86.8%) SI: 96/231 (41.6%) had died, 86 (37.2%) were alive and SI, and 49 (21.2%) were alive and no longer considered SI. The annualized mortality rate for these 231 SI patients was 35.6%.


In this ethnically diverse, geographically dispersed dialysis population, we found that use of the SQ was pragmatically feasible and effective in identifying SI who were at considerably increased risk of one-year mortality. Future research is needed to determine if proactive identification of SI in this manner leads to improved palliative care with more goal-concordant care for this at-risk population.


  • Private Foundation Support