Chen et al reported a clinical prediction score for referring an elderly dialysis patient for renal transplant. This can help to identify a patient who may have a better survival. The authors are from University of California Davis and University of Chicago.
Patient: age >= 70 years, on dialysis
Parameters:
(1) sex
(2) age in years
(3) race/ethnicity
(4) primary disease
(5) body mass index
(6) employment status
(7) nephrologist care
(8) dialysis access
(9) congestive heart failure
(10) atherosclerotic heart disease
(11) other cardiac disease
(12) cerebrovascular accident or TIA
(13) peripheral vascular disease
(14) hypertension
(15) amputation
(16) insulin dependent diabetes mellitus
(17) chronic obstructive pulmonary disease
(18) tobacco use
(19) cancer
(20) immobility
(21) needs assistance with activities of daily living (ADL)
(22) institutionalized
|
Parameter |
Finding |
Points |
|
sex |
female |
0 |
|
|
male |
2 |
|
age |
70 to 74 years |
0 |
|
|
75 to 79 years |
3 |
|
|
80 to 84 years |
8 |
|
|
>= 85 years |
15 |
|
ethnicity |
non-Hispanic white |
0 |
|
|
non-Hispanic black |
-6 |
|
|
Hispanic |
-7 |
|
|
Asian |
-9 |
|
primary disease |
diabetes |
0 |
|
|
hypertension |
-4 |
|
|
glomerulonephritis |
-5 |
|
|
cystic |
-8 |
|
|
urologic |
-7 |
|
|
other cause |
-2 |
|
|
unknown |
-2 |
|
BMI |
< 18 kg per sq m |
8 |
|
|
18 to 24.9 |
3 |
|
|
25 to 34.9 |
0 |
|
|
>= 35 |
0 |
|
employment status |
retired |
0 |
|
|
employed |
-4 |
|
nephrologist care |
no |
1 |
|
|
yes |
0 |
|
dialysis access |
catheter |
-6 |
|
|
arteriovenous fistula |
-3 |
|
|
peritoneal dialysis |
0 |
|
congestive heart failure |
no |
0 |
|
|
yes |
5 |
|
atherosclerotic heart |
no |
0 |
|
|
yes |
1 |
|
other cardiac |
no |
0 |
|
|
yes |
2 |
|
cerebrovascular/TIA |
no |
0 |
|
|
yes |
2 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
2 |
|
hypertension |
no |
0 |
|
|
yes |
-3 |
|
amputation |
no |
0 |
|
|
yes |
3 |
|
insulin-dependent diabetes |
no |
0 |
|
|
yes |
2 |
|
COPD |
no |
0 |
|
|
yes |
5 |
|
tobacco |
no |
0 |
|
|
yes |
3 |
|
cancer |
no |
0 |
|
|
yes |
3 |
|
immobility |
no |
0 |
|
|
yes |
4 |
|
needs assistance |
no |
0 |
|
|
yes |
3 |
|
institutionalized |
no |
0 |
|
|
yes |
6 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -30
• maximum score: 66
• The higher the score the greater the 5-year mortality rate (relative to starting dialysis).
|
Score |
Score Group |
5-Year Mortality Rate (Derivation Cohort) |
|
<= -9 |
1 |
51% |
|
-8 to -4 |
2 |
61% |
|
-3 to 1 |
3 |
70% |
|
2 to 9 |
4 |
80% |
|
>=10 |
5 |
91% |
Performance:
• The area under the ROC curve is 0.71.
Specialty: Nephrology
