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Titolo Development and validation of a predictive mortality risk score from a European hemodialysis cohort
Autore JUrgen Floege1, Iain A. Gillespie2, Florian Kronenberg3, Stefan D. Anker4, Ioanna Gioni5, Sharon Richards6,Ronald L. Pisoni7, Bruce M. Robinson7, Daniele Marcelli8, Marc Froissart9, Kai-Uwe Eckardt10 on behalf of the ARO Steering Committee (collaborators)11
Referenza Kidney International 2015; doi:10.1038/ki.2014.419
Contenuto

Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decisionmaking, 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.

Data 29.04.2015
 
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