Predicting mortality risk on dialysis and conservative care: development and internal validation of a prediction tool for older patients with advanced chronic kidney disease.
Predicting mortality risk on dialysis and conservative care: development and internal validation of a prediction tool for older patients with advanced chronic kidney disease.
复制标题
预测透析和保守护理的死亡率风险：针对患有晚期慢性肾脏疾病的老年患者的预测工具的开发和内部验证。
DOI：
10.1093/ckj/sfaa021
复制
发表时间：
2021-01
影响因子：
4.6
通讯作者：
van Diepen M
中科院分区：
文献类型：
--
作者：
Ramspek CL;Verberne WR;van Buren M;Dekker FW;Bos WJW;van Diepen M
对于某些老年晚期慢性肾病(CKD)患者，保守治疗(CC)可能是一种有效的透析替代方案。在两种治疗途径上预测患者预后的模型可能在共享决策中具有价值。因此，目的是开发一种预测工具，从治疗决定的时间开始预测同一患者透析和CC的死亡风险。2004年至2016年期间，在荷兰的一个中心接受治疗的CKD4/5期患者年龄为70岁≥ 。在治疗决策时收集预测因素，并根据文献和专家小组进行选择。结果是2年死亡率。分别建立了透析组和CC组的基本和扩展Logistic回归模型。这些模型通过Bootstrapping进行了内部验证。通过区分和校准来评估模型的性能。总共纳入了366名患者，其中126名选择了CC。为基础模型预先选择的预测因子是年龄、估计的肾小球滤过率、恶性肿瘤和心血管疾病。歧视是温和的，乐观修正后的C-统计数据从0.675到0.750不等。标定曲线显示出良好的标定效果。一种预测两年死亡率的预测工具被开发出来，为老年晚期CKD患者提供透析和CC的个体化预后评估。需要进一步的研究来测试我们的发现是否适用于其他CKD人群。经过外部验证后，这一预测工具可用于比较透析和CC患者的预后，并有助于为治疗决策提供信息。
Conservative care (CC) may be a valid alternative to dialysis for certain older patients with advanced chronic kidney disease (CKD). A model that predicts patient prognosis on both treatment pathways could be of value in shared decision-making. Therefore, the aim is to develop a prediction tool that predicts the mortality risk for the same patient for both dialysis and CC from the time of treatment decision. CKD Stage 4/5 patients aged ≥70 years, treated at a single centre in the Netherlands, were included between 2004 and 2016. Predictors were collected at treatment decision and selected based on literature and an expert panel. Outcome was 2-year mortality. Basic and extended logistic regression models were developed for both the dialysis and CC groups. These models were internally validated with bootstrapping. Model performance was assessed with discrimination and calibration. In total, 366 patients were included, of which 126 chose CC. Pre-selected predictors for the basic model were age, estimated glomerular filtration rate, malignancy and cardiovascular disease. Discrimination was moderate, with optimism-corrected C-statistics ranging from 0.675 to 0.750. Calibration plots showed good calibration. A prediction tool that predicts 2-year mortality was developed to provide older advanced CKD patients with individualized prognosis estimates for both dialysis and CC. Future studies are needed to test whether our findings hold in other CKD populations. Following external validation, this prediction tool could be used to compare a patient’s prognosis on both dialysis and CC, and help to inform treatment decision-making.
登录
查看更多内容
影响因子：
6.1
作者：
Singh, Pooja;Germain, Michael J.;Unruh, Mark
通讯作者：
Unruh, Mark
DOI：
10.2215/cjn.03860609
发表时间：
2010-01-01
影响因子：
9.8
作者：
Cohen, Lewis M.;Ruthazer, Robin;Germain, Michael J.
通讯作者：
Germain, Michael J.
影响因子：
2.8
作者：
Burns, Aine;Carson, Rachel
通讯作者：
Carson, Rachel
影响因子：
3.9
作者：
Ramspek CL;Voskamp PW;van Ittersum FJ;Krediet RT;Dekker FW;van Diepen M
通讯作者：
van Diepen M
影响因子：
2.3
作者：
Austin PC;Steyerberg EW
通讯作者：
Steyerberg EW