Kidney research and clinical practice · 2025
Prediction model for 6-month mortality in incident older hemodialysis patients in South Korea.
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Park Woo Yeong, Bae Eunjin, Lee Hui-Seung, Lim Chi-Yeon, Cho Jang-Hee, Yu Byung Chul, Han Miyeun, Song Sang Heon, Ko Gang-Jee, Yang Jae Won, Chung Sungjin, Hong Yu Ah, Hyun Young Youl, Sun In O, Kim Hyunsuk, Hwang Won Min, Shin Sung Joon, Kwon Soon Hyo, Yoo Kyung Don
Аннотация
BACKGROUND: Early mortality following hemodialysis initiation hinders survival improvement in older patients. This study aimed to develop a clinical risk model for predicting 6-month mortality after dialysis initiation in older Korean hemodialysis patients.
METHODS: We analyzed data from incident hemodialysis patients aged >70 years from the Korean Society of Geriatric Nephrology (KSGN) database. A prediction model was developed using multivariate logistic regression analysis and externally validated with independent datasets.
RESULTS: Among 1,751 incident hemodialysis patients, the 6-month mortality rate was 15.5%. Using multivariate logistic analysis, we constructed the KSGN score as an independent risk factor for 6-month mortality, and its components and score are as follows: old age at dialysis initiation (≥85 years, score 2); hypertension and renovascular disease as a primary etiology of end-stage kidney disease (ESKD) (score 1); malignancy history (yes, score 1); low serum albumin (<3.5 g/dL, score 1); hypertension treatment (yes, score -1); prepared vascular access on maintenance dialysis (arteriovenous fistula/arteriovenous graft, score -3). In the development cohort, the area under the curve (AUC) for the KSGN score was significantly higher than the Alberta Wick's score (0.707 vs. 0.683, p = 0.001). In the validation cohort, the KSGN score's performance was comparable to existing models.
CONCLUSION: The KSGN score may be a valuable tool for predicting early mortality after dialysis initiation in older patients with ESKD, aiding in decision-making and management regarding dialysis initiation.
METHODS: We analyzed data from incident hemodialysis patients aged >70 years from the Korean Society of Geriatric Nephrology (KSGN) database. A prediction model was developed using multivariate logistic regression analysis and externally validated with independent datasets.
RESULTS: Among 1,751 incident hemodialysis patients, the 6-month mortality rate was 15.5%. Using multivariate logistic analysis, we constructed the KSGN score as an independent risk factor for 6-month mortality, and its components and score are as follows: old age at dialysis initiation (≥85 years, score 2); hypertension and renovascular disease as a primary etiology of end-stage kidney disease (ESKD) (score 1); malignancy history (yes, score 1); low serum albumin (<3.5 g/dL, score 1); hypertension treatment (yes, score -1); prepared vascular access on maintenance dialysis (arteriovenous fistula/arteriovenous graft, score -3). In the development cohort, the area under the curve (AUC) for the KSGN score was significantly higher than the Alberta Wick's score (0.707 vs. 0.683, p = 0.001). In the validation cohort, the KSGN score's performance was comparable to existing models.
CONCLUSION: The KSGN score may be a valuable tool for predicting early mortality after dialysis initiation in older patients with ESKD, aiding in decision-making and management regarding dialysis initiation.