A Current Approach to Estimating the Body Composition of Patients on Hemodialysis

Yakovenko, Alexander; Rumyantsev, A. Sh.; Somova, V. M.

doi:10.29296/25877305-2018-01-12

Cited by 1 publication

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“…При этом мы не включали в модель индекс массы тела в связи с интегральным характером этого показателя и недо-статочной репрезентативностью этого метода [29]. В частности, рост пациентов можно включать в модель только на старте диализа.…”

Section: Discussionunclassified

Dialysis Start Timing: Development and Validation of Start Scoring Scale

Земченков

Gerasimchuk²,

Sabodash

et al. 2018

RJTAO

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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.

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Section: Discussionunclassified