Aim.The optimal time for initiating of chronic dialysis remains unknown. The scale for mortality risk assessment could help in decision-making concerning dialysis start timing.Methods.We randomly divided 1856 patients started dialysis in 2009–2016 into developmental and validation group (1:1) to create and validate scoring system «START» predicting mortality risk at dialysis initiation in order to fi nd unmodifi able and modifi able factors which could help in the decision-making of dialysis start. In the series of univariate regression models in the developmental set, we evaluated the mortality risk linked with available parameters: age, eGFR, serum phosphate, total calcium, hemoglobin, Charlson comorbidity index, diabetes status, urgency of start (turned to be signifi cant) and gender, serum sodium, potassium, blood pressure (without impact on survival). Similar hazard ratios were converted to score points.Results.The START score was highly predictive of death: C-statistic was 0.82 (95% CI 0.79–0.85) for the developmental dataset and 0.79 (95% CI 0.74–0.84) for validation dataset (both p < 0.001). On applying the cutoff between 7–8 points in the developmental dataset, the risk score was highly sensitive 81.1% and specifi c 67.9%; for validation dataset, the sensitivity was 78.9%, specifi city 67.9%. We confi rmed the similarity in survival prediction in the validation set to developmental set in low, medium and high START score groups. The difference in survival between three levels of START-score in validation set remained similar to that of developmental set: Wilcoxon = 8.78 (p = 0.02) vs 15.31 (p < 0.001) comparing low–medium levels and 25.18 (p < 0.001) vs 39.21 (p < 0.001) comparing medium–high levels.Conclusion.Developed START score system including modifi able factors showed good mortality prediction and could be used in dialysis start decision-making.
Introduction and Aims: Recent changes in bone and mineral disorders target parameters led to substantial shifts in spectrum of the PTH levels among dialysis patients and aroused interest in different ways of hyperparathyroidism correction facing substantial cost of pharmacologic intervention and its adverse event frequency. Minimally invasive intervention (vitamin D or ethanol injections in parathyroid glands) could have results compatible with conservative strategies and parathyroidectomy at fewer expenses and with less adverse effects. While detailed indications for each approach remain relatively unclear the comparative studies open the possibility to reveal the optimal strategy. Methods: In 42 dialysis patients (age 47±13 y; dialysis vintage 43±30 mo; female -31; 34 -on peritoneal dialysis) we conducted 58 series of vitamin D receptor activator (VDRA) or ethanol injections in the parathyroid glands under Ultrasound (US) control (including 14 series of simultaneous injection in two glands and 9 repeated series with 20±16 months intervals). The glands were beforehand identified by US examination and scintigraphy (Tc-99m-sestamibi). The indication for injection were: (1) one or two glands with marked diffuse hypertrophy or adenoma; (2) the size of each gland was less
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