Validation of risk prediction tools in elderly patients who initiate dialysis

Abstract

PURPOSE: The number of elderly patients with end-stage renal disease on maintenance dialysis therapy is gradually increasing. The elderly population has difficulties in making decisions regarding initiation of dialysis treatment because of their high morbidity and frailty. The purpose of this study was to determine the best prognostic tool in predicting short-term mortality in elderly patients undergoing dialysis. METHODS: This study is a multicenter retrospective study. We enrolled patients, aged ≥75 years, who began hemodialysis at three university hospitals in Korea from January 2010 to December 2016. We applied two comorbidity-based score tools (Thamer and Wick, each consisting of seven variables) and the Clinical Frailty Scale (CFS, seven scales), which were validated for mortality prediction in elderly incident patients. Patient's information was obtained from electronic medical records in the participating center, and mortality data (up to December 2016) were obtained from the Korean National Statistical Office. Models were compared using the area under the receiver operating characteristic curve. RESULTS: Among the 219 patients enrolled in this study, the 3- and 6-month mortality rates were 31 (14.4%) and 48 (22.4%), respectively. Receiver operating characteristic curve analysis revealed that both score systems and the CFS showed similar performance while predicting 3- and 6-month mortality. The scores from these indices correlated with survival time. CONCLUSION: Predicting short-term mortality and long-term survival time for elderly patients is possible using the Thamer and Wick scores and the CFS.