Weiss et al developed models for predicting mortality in older adults with severe kidney disease. These can help to identify a patient who may benefit from more aggressive management. The authors are from Oregon Health and Sciences University, McGill University, Kaiser Permanente Northwest and Veterans Administration Puget Sound Healthcare.
Patient selection: kidney disease, age 65 to 79 years, GFR <= 30 mL per min per 1.73 square meter
Parameters:
(1) index GFR in mL per min per 1.73 square meters, from 2 to 30
(2) second GFR in mL per min per 1.73 square meters, from 5 to 30
(3) baseline systolic blood pressure in mm Hg, from 80 to 240
(4) age in years
(5) body mass index (BMI) in kg per square meter, from 10 to 60
(6) gender
(7) history of renal failure
(8) history of cardiovascular disease
(9) tobacco use
(10) history of hypertension
(11) therapy with a statin
(12) number of non-disease specific measures (weight loss >= 10 lbs in 12 months, orthostatic hypotension, hip fracture in the 2 years prior to entry, dementia diagnosis in the 3 months prior to entry, fall in 2 years prior to entry, >= 2 ED or hospital admissions in 2 years prior to entry)
points for initial GFR =
= (-0.02394 * ((GFR)^2)) - (2.78 * (GFR)) + 105.2
points for second GFR =
= (0.04281 * ((GFR)^2)) - (0.4583 * (GFR)) + 4.945
points for systolic blood pressure =
= (-0.001202 * ((SBP)^2)) + (0.1604 * (SBP)) + 30.36
points for age 65 to 70 years
= (3.4 * (age)) - 221
points for 70 to 75 years
= (0.2 * (age)) + 3
points for 75 to 79 years =
= ((age) - 57
points for BMI from 40 to 60 =
= (0.1 * (BMI)) - 4
points for BMI from 30 to 40 =
= 28 - (0.7 * (BMI))
points for BMI from 10 to 30 =
= (140.5 - (4.5 * (BMI))
|
Parameter
|
Finding
|
Points
|
|
gender
|
male
|
24
|
|
|
female
|
0
|
|
history of renal failure
|
absent
|
0
|
|
|
present
|
46
|
|
history of cardiovascular disease
|
absent
|
0
|
|
|
present
|
25
|
|
tobacco use
|
absent
|
0
|
|
|
present
|
14
|
|
history of hypertension
|
absent
|
12
|
|
|
present
|
0
|
|
therapy with a statin
|
yes
|
0
|
|
|
no
|
23
|
|
number of non-disease specific measures
|
0
|
0
|
|
|
1 or 2
|
44
|
|
|
3 to 6
|
51
|
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 478
• The higher the score the greater the risk of mortality.
|
Score
|
2-Year Mortality
|
|
< 66
|
< 5%
|
|
66 to 244
|
(0.0011 * ((score)^2)) - (0.13 * (score)) + 9.1
|
|
244 to 361
|
(-0.001085 * ((score)^2)) + (1.1 * (score)) - 159.6
|
|
> 361
|
> 95%
|
Performance:
• The area under the ROC curve is 0.68.
