Kidney Week

Abstract: TH-PO928

Development of a Prognostic Risk Score to Predict Early Mortality in Incident Elderly Japanese Patients on Hemodialysis

Session Information

• Geriatric Nephrology: Innovations and Insights
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1300 Geriatric Nephrology

Authors

• Okada, Hirokazu, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan

Hirokazu Okada, MD, DrMed, PhD

• Sakai, Ken, Toho Daigaku, Ota-ku, Tokyo, Japan

Ken Sakai, MD, PhD

• Narita, Ichiei, Niigata Daigaku, Niigata, Niigata, Japan

Ichiei Narita, MD, PhD

• Moriyama, Toshiki, Osaka Daigaku, Suita, Osaka, Japan

Toshiki Moriyama, MD, PhD

• Isaka, Yoshitaka, Osaka Daigaku, Suita, Osaka, Japan

Yoshitaka Isaka, MD, PhD

• Fukami, Kei, Kurume Daigaku Igakubu Daigakuin Igaku Kenkyuka, Kurume, Fukuoka, Japan

Kei Fukami, MD, PhD

• Kanda, Eiichiro, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan

Eiichiro Kanda, MD, PhD, MPH

• Kashihara, Naoki, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan

Naoki Kashihara, MD, PhD

Background

Information of short-term prognosis after hemodialysis (HD) introduction is important for elderly patients with chronic kidney disease (CKD) and their families choosing a modality of renal replacement therapy. Therefore, we developed a risk score to predict early mortality in incident elderly Japanese hemodialysis patients.

Methods

We analyzed data of incident elderly HD patients from a nationwide cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) to develop a prognostic risk score. Candidate risk factors for early death within 1 year was evaluated using multivariate logistic regression analysis. The risk score was developed by summing up points derived from parameter estimate values of independent risk factors. The association between risk score and early death was tested using Cox proportional hazards models. This risk score was validated twice by using an internal validation cohort derived from the JRDR and an external validation cohort collected for this study.

Results

Using the development cohort (n=2,000), nine risk factors were retained in the risk score: older age (>85), yes=2, no=0; sex, male=2, female=0; lower body mass index (<20), yes=2, no=0; cancer, yes=1, no=0; dementia, yes=3, no=0; lower creatinine (<6.5 mg/dL), yes=1, no=0; lower albumin (<3.0 g/dL), yes=3, no=0; normal or high calcium (>8.5 mg/dL), yes=1, no=0; and higher C reactive protein (>2.0 mg/dL), yes=2, no=0. In the internal and external validation cohorts (n=739, 140, respectively), the medium- and high-risk groups (total score, 6 to 10 and 11 or more, respectively) showed significantly higher risk of early death than the low-risk group (total score, 0 to 5) (p<0.001).

Conclusion

We developed a prognostic risk score predicting early death within 1 year in incident elderly Japanese HD patients, which may help detect elderly patients with a high-risk of early death after HD introduction.

Funding

• Government Support – Non-U.S.