Ramspek Chava L, Verberne Wouter R, van Buren Marjolijn, Dekker Friedo W, Bos Willem Jan W, van Diepen Merel
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
Clin Kidney J. 2020 Mar 17;14(1):189-196. doi: 10.1093/ckj/sfaa021. eCollection 2021 Jan.
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.
对于某些患有晚期慢性肾脏病（CKD）的老年患者，保守治疗（CC）可能是透析的有效替代方案。一个能够预测两种治疗途径下患者预后的模型在共同决策中可能具有价值。因此，目标是开发一种预测工具，从治疗决策时起预测同一患者接受透析和CC治疗的死亡风险。
纳入2004年至2016年期间在荷兰单一中心接受治疗的年龄≥70岁的CKD 4/5期患者。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。结局为2年死亡率。为透析组和CC组分别建立了基本和扩展逻辑回归模型。这些模型通过自抽样进行内部验证。通过区分度和校准评估模型性能。
共纳入366例患者，其中126例选择CC。基本模型预先选择的预测因素为年龄、估计肾小球滤过率、恶性肿瘤和心血管疾病。区分度中等，乐观校正的C统计量范围为0.675至0.750。校准图显示校准良好。
开发了一种预测2年死亡率的预测工具，为老年晚期CKD患者提供透析和CC治疗的个体化预后估计。需要进一步研究以检验我们的发现在其他CKD人群中是否成立。经过外部验证后，该预测工具可用于比较患者透析和CC治疗的预后，并有助于指导治疗决策。
