Park Woo Yeong, Bae Eunjin, Lee Hui-Seung, Lim Chi-Yeon, Cho Jang-Hee, Yu Byung Chul, Han Miyeun, Song Sang Heon, Ko Gang-Jee, Yang Jae Won, Chung Sungjin, Hong Yu Ah, Hyun Young Youl, Sun In O, Kim Hyunsuk, Hwang Won Min, Shin Sung Joon, Kwon Soon Hyo, Yoo Kyung Don
Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.
Korean Society of Geriatric Nephrology, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2025 Apr 25. doi: 10.23876/j.krcp.23.224.
Early mortality following hemodialysis initiation hinders survival improvement in older patients. This study aimed to develop a clinical risk model for predicting 6-month mortality after dialysis initiation in older Korean hemodialysis patients.
We analyzed data from incident hemodialysis patients aged >70 years from the Korean Society of Geriatric Nephrology (KSGN) database. A prediction model was developed using multivariate logistic regression analysis and externally validated with independent datasets.
Among 1,751 incident hemodialysis patients, the 6-month mortality rate was 15.5%. Using multivariate logistic analysis, we constructed the KSGN score as an independent risk factor for 6-month mortality, and its components and score are as follows: old age at dialysis initiation (≥85 years, score 2); hypertension and renovascular disease as a primary etiology of end-stage kidney disease (ESKD) (score 1); malignancy history (yes, score 1); low serum albumin (<3.5 g/dL, score 1); hypertension treatment (yes, score -1); prepared vascular access on maintenance dialysis (arteriovenous fistula/ arteriovenous graft, score -3). In the development cohort, the area under the curve (AUC) for the KSGN score was significantly higher than the Alberta Wick's score (0.707 vs. 0.683, p = 0.001). In the validation cohort, the KSGN score's performance was comparable to existing models.
The KSGN score may be a valuable tool for predicting early mortality after dialysis initiation in older patients with ESKD, aiding in decision-making and management regarding dialysis initiation.
开始血液透析后的早期死亡率阻碍了老年患者生存率的提高。本研究旨在建立一个临床风险模型，以预测韩国老年血液透析患者开始透析后6个月的死亡率。
我们分析了韩国老年肾脏病学会（KSGN）数据库中年龄>70岁的新发性血液透析患者的数据。使用多因素逻辑回归分析建立预测模型，并使用独立数据集进行外部验证。
在1751例新发性血液透析患者中，6个月死亡率为15.5%。通过多因素逻辑分析，我们构建了KSGN评分作为6个月死亡率的独立危险因素，其组成部分和评分如下：开始透析时年龄较大（≥85岁，评分2）；高血压和肾血管疾病作为终末期肾病（ESKD）的主要病因（评分1）；有恶性肿瘤病史（是，评分1）；血清白蛋白水平低（<3.5 g/dL，评分1）；接受高血压治疗（是，评分-1）；维持性透析时有准备好的血管通路（动静脉内瘘/动静脉移植物，评分-3）。在开发队列中，KSGN评分的曲线下面积（AUC）显著高于艾伯塔威克评分（0.707对0.683，p = 0.001）。在验证队列中，KSGN评分的表现与现有模型相当。
KSGN评分可能是预测ESKD老年患者开始透析后早期死亡率的有价值工具，有助于在开始透析的决策和管理方面提供帮助。
