Low performance of prognostic tools for predicting death before dialysis in older patients with advanced CKD

Prouvot, Julien; Pambrun, Emilie; Antoine, Valéry; Couchoud, Cécile; Vigneau, Cécile; Roche, Sophie; François, Maud; Mariat, Christophe; Babici, Daniela; Prelipcean, Camelia; Moranne, Olivier; Investigators, Pspa Study

doi:10.1007/s40620-021-01180-1

Cited by 8 publications

(5 citation statements)

References 54 publications

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“…(37) In previous French validation studies the Grams model was externally validated in a cohort of advanced CKD patients aged 75 years and older for the outcomes KRT and 'death without KRT'. (7,8) These studies reported a C-statistic of 0.64 and 0.65 for KRT and a Cstatistic of 0.68 and 0.70 for 'death without KRT' for the 2 and 4 year models, respectively. Our decision curve analysis showed that for most patients, using individualized risk thresholds has a higher potential clinical utility than using eGFR thresholds, though the eGFR<15 guideline also showed good performance.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Ramspek

Boekee²,

Evans³

et al. 2022

Kidney International Reports

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Section: Discussionmentioning

confidence: 99%

“…To our knowledge, the Grams model has only been externally validated for the outcome KRT and death before dialysis and has yet to be validated for cardiovascular disease (CVD) and overall death. 4 , 7 , 8 Before use, external validation of prediction models is crucial in order to determine the accuracy in new patients.…”

mentioning

confidence: 99%

Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Ramspek

Boekee²,

Evans³

et al. 2022

Kidney International Reports

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“…To guide nephrologists in their daily practice and the patients’ decisional process, prognostic scores have an increasingly important role to play. However, the scores developed have shown limited accuracy in the older adults ( 47 , 48 ). Furthermore, using mortality as the outcome of choice must be questioned in the older adults: (i) the mortality rate is very high in this population burdened by comorbidities and clinical frailty ( 2 ); older patients often place more importance on their quality of life than on life expectancy.…”

Section: Prospects For Renal Registries and Researchmentioning

confidence: 99%

What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?

Moranne

Hamroun²,

Couchoud³

2023

Front. Nephrol.

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The aim of this paper is to illustrate all the clinical epidemiology searches made within the French network REIN to improve CKD stage 4-5 care in older adults. We summarize various studies describing clinical practice, care organization, prognosis and health economics evaluation in order to develop personalized care plans and decision-making tools. In France, for 20 years now, various databases have been mobilized including the national REIN registry which includes all patients receiving dialysis or transplantation. REIN data are indirectly linked to the French administrative healthcare database. They are also pooled with data from the PSPA cohort, a multicenter prospective cohort study of patients aged 75 or over with advanced CKD, monitored for 5 years, and the CKD-REIN clinical-based prospective cohort which included 3033 patients with CKD stage 3-4 from 2013 to 2016. During our various research work, we identified heterogeneous trajectories specific to this growing older population, raising ethical, organizational and economic issues. Renal registries will help clinicians, health providers and policy-makers if suitable decision- making tools are developed and validated.

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“…Moreover, a recent review by Prouvot et al [8] found other four equations (SCHMIDT [9]; WEISS [10]; GOLDFARB [11]; LANDRAY [12]) predicting death before dialysis in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

“…The Kidney Disease Improving Global Outcome 3 and the International Society of Nephrology 5 recommendations also highlight the interest of using prognostic scores to predict death or start of renal replacement therapy for shared medical decisions; the scores suggested are the GRAMS 6 and BANSAL 7 scores. Moreover, a recent review by Prouvot et al 8 found other four equations (Schmidt et al, 9 Weiss et al, 10 Goldfarb-Rumyantzev et al, 11 and Landray et al 12 ) predicting death before dialysis in CKD patients.…”

Section: Introductionmentioning

confidence: 99%

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study

et al. 2023

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Introduction: Kidney Disease Outcomes Quality Initiative clinical practice guidelines recommend avoiding placement of peripherally inserted vascular access devices in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. On the other hand, many patients with severe chronic kidney disease (CKD) have poor prognosis. This study carried out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) and Beclap score in patients with PICCs or Midlines, assuming that in those with an estimated high mortality rate at 2 years, it could be acceptable to implant a peripheral vascular access device (PVAD) despite the presence of CKD. Methods: We analyzed data on patients with PICCs or Midlines inserted from October 2018 to November 2019. CCI, Beclap score, and eGFR were calculated for each patient at the time of the catheter insertion. We then followed patients for 2 years to assess 2-year mortality for each. Results: One hundred and thirty-one patients were enrolled, 49 (37.4%) had eGFR<45 ml. The 2-year mortality rate was 57.3%. The cut off derived from ROC curve analysis of 15 for Beclap score and 5 for CCI, showed good sensitivity and specificity in predicting mortality of the total population, patients without an oncological disease and patients with eGFR<45 ml/min. Conclusion: CCI and Beclap score are good predictors of mortality at 2 years. Physicians and nurses can use these tools in the evaluation of patients at risk for future dialysis, instead of relying exclusively on renal function to decide whether implanting PICCs, Midlines, or other vascular access devices.

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Low performance of prognostic tools for predicting death before dialysis in older patients with advanced CKD

Cited by 8 publications

References 54 publications

Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients

What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study

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