Khan et al identified risk groups for patients undergoing renal replacement therapy. A patient at higher risk may benefit from more aggressive management or treatment with a novel therapy. The authors are from the University of Aberdeen, Aberdeen Royal Infirmary and Ninewells Hospital in Dundee.
Patient selection: end-stage renal disease treated by hemodialysis, continuous abdominal peritoneal dialysis or renal transplantation
Parameters:
(1) age
(2) comorbid conditions
Age in Years |
Comorbid Conditions |
Risk Group |
> 80 years |
NA |
high |
NA |
end stage renal disease plus >= 2 organ dysfunctions |
high |
NA |
diabetes and cardiopulmonary disease |
high |
NA |
visceral malignancy |
high |
70 to 80 years |
NA |
medium |
< 70 years |
diabetes mellitus |
medium |
< 80 years |
>= 1 comorbid conditions (see below) |
medium |
< 70 |
none |
low |
where:
• The medium risk group with age < 80 and >= 1 comorbid factor could be rewritten as < 70 and >= 1 comorbid factor since 70-80 already is at medium risk.
• The visceral malignancy probably should only be applied if uncontrolled. Hematologic malignancy should also confer risk.
• Should a patient with multiple medium risk criteria met be bumped up to high risk?
Comorbid conditions:
(1) angina
(2) previous myocardial infarction
(3) cardiac failure
(4) chronic obstructive airways disease
(5) pulmonary fibrosis
(6) liver disease (cirrhosis, chronic hepatitis)
Purpose: To evaluate a patient undergoing renal replacement therapy based on the risk groups of Khan et al.
Specialty: Nephrology, Clinical Laboratory
Objective: risk factors, comorbid conditions
ICD-10: N17-N19,