Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Research Division, Institute for Health Outcomes and Process Evaluation research (iHope International), Kyoto, Japan.
Nephrol Dial Transplant. 2018 Aug 1;33(8):1452-1458. doi: 10.1093/ndt/gfx260.
Among aging hemodialysis patients, loss of physical function has become a major issue. We developed and validated a model of predicting loss of physical function among elderly hemodialysis patients.
We conducted a cohort study involving maintenance hemodialysis patients ≥65 years of age from the Dialysis Outcomes and Practice Pattern Study in Japan. The derivation cohort included 593 early phase (1996-2004) patients and the temporal validation cohort included 447 late-phase (2005-12) patients. The main outcome was the incidence of loss of physical function, defined as the 12-item Short Form Health Survey physical function score decreasing to 0 within a year. Using backward stepwise logistic regression by Akaike's Information Criteria, six predictors (age, gender, dementia, mental health, moderate activity and ascending stairs) were selected for the final model. Points were assigned based on the regression coefficients and the total score was calculated by summing the points for each predictor.
In total, 65 (11.0%) and 53 (11.9%) hemodialysis patients lost their physical function within 1 year in the derivation and validation cohorts, respectively. This model has good predictive performance quantified by both discrimination and calibration. The proportion of the loss of physical function increased sequentially through low-, middle-, and high-score categories based on the model (2.5%, 11.7% and 22.3% in the validation cohort, respectively). The loss of physical function was strongly associated with 1-year mortality [adjusted odds ratio 2.48 (95% confidence interval 1.26-4.91)].
We developed and validated a risk prediction model with good predictive performance for loss of physical function in elderly hemodialysis patients. Our simple prediction model may help physicians and patients make more informed decisions for healthy longevity.
在老年血液透析患者中，身体功能的丧失已成为一个主要问题。我们开发并验证了一个预测老年血液透析患者身体功能丧失的模型。
我们进行了一项队列研究，纳入了来自日本透析结局和实践模式研究的年龄≥65 岁的维持性血液透析患者。推导队列包括 593 例早期（1996-2004 年）患者，时间验证队列包括 447 例晚期（2005-12 年）患者。主要结局是身体功能丧失的发生率，定义为在一年内 12 项简短健康调查身体功能评分降至 0。使用 Akaike 信息准则的向后逐步逻辑回归，选择了 6 个预测因子（年龄、性别、痴呆、心理健康、适度活动和上楼梯）进入最终模型。根据回归系数给分，并通过对每个预测因子的得分求和计算总分。
在推导队列和验证队列中，分别有 65 例（11.0%）和 53 例（11.9%）血液透析患者在 1 年内丧失了身体功能。该模型具有良好的预测性能，通过区分度和校准度都可以量化。根据模型，低、中、高得分类别中身体功能丧失的比例逐渐增加（验证队列中分别为 2.5%、11.7%和 22.3%）。身体功能丧失与 1 年死亡率密切相关[调整后的优势比为 2.48（95%置信区间 1.26-4.91）]。
我们开发并验证了一个预测老年血液透析患者身体功能丧失的风险预测模型，该模型具有良好的预测性能。我们的简单预测模型可以帮助医生和患者更明智地做出健康长寿的决策。
