Development and validation of a predictive mortality risk score from a European hemodialysis cohort

Floege J, Gillespie IA, Kronenberg F, Anker SD, Gioni I, Richards S, Pisoni RL, Robinson BM, Marcelli D, Froissart M, Eckardt KU (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Kidney International Nature Publishing Group: Open Access Hybrid Model Option A

Book Volume: 87

Pages Range: 996-1008

Journal Issue: 5

DOI: 10.1038/ki.2014.419

Abstract

Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decision-making, those currently available have limited applicability, robustness, and generalizability. Here we applied a modified Framingham Heart Study approach to derive 1- and 2-year all-cause mortality risk scores using a 11,508 European incident HD patient database (AROii) recruited between 2007 and 2009. This scoring model was validated externally using similar-sized Dialysis Outcomes and Practice Patterns Survey (DOPPS) data. For AROii, the observed 1- and 2-year mortality rates were 13.0 (95% confidence interval (CI; 12.3-13.8)) and 11.2 (10.4-12.1)/100 patient years, respectively. Increasing age, low body mass index, history of cardiovascular disease or cancer, and use of a vascular access catheter during baseline were consistent predictors of mortality. Among baseline laboratory markers, hemoglobin, ferritin, C-reactive protein, serum albumin, and creatinine predicted death within 1 and 2 years. When applied to the DOPPS population, the predictive risk score models were highly discriminatory, and generalizability remained high when restricted by incidence/prevalence and geographic location (C-statistics 0.68-0.79). This new model offers improved predictive power over age/comorbidity-based models and also predicted early mortality (C-statistic 0.71). Our new model delivers a robust and reproducible mortality risk score, based on readily available clinical and laboratory data.

Authors with CRIS profile

Kai-Uwe Eckardt Department of Medicine 4 – Nephrology and Hypertension

Involved external institutions

Amgen Ltd GB United Kingdom (GB) Amgen Europe GmbH CH Switzerland (CH) Arbor Research Collaborative for Health US United States (USA) (US) Universitätsklinikum Göttingen DE Germany (DE) Medizinische Universität Innsbruck AT Austria (AT) Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen DE Germany (DE) Fresenius Medical Care Deutschland GmbH DE Germany (DE)

How to cite

APA:

Floege, J., Gillespie, I.A., Kronenberg, F., Anker, S.D., Gioni, I., Richards, S.,... Eckardt, K.-U. (2015). Development and validation of a predictive mortality risk score from a European hemodialysis cohort. Kidney International, 87(5), 996-1008. https://doi.org/10.1038/ki.2014.419

MLA:

Floege, Juergen, et al. "Development and validation of a predictive mortality risk score from a European hemodialysis cohort." Kidney International 87.5 (2015): 996-1008.

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