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Revisiting risk prediction tools for death and end-stage renal disease in older patients with advanced chronic kidney
Andra Nastasa1, Hani Hussien2,3, Mugurel Apetrii1,4
1"Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, Iasi, Romania.
Insights
Elderly patients with advanced chronic kidney disease (CKD) face high risks of mortality and complications. Integrating risk scores with geriatric assessments reveals significant survival disparities and increased need for dialysis in high-risk groups.
Area of Science:
- Gerontology
- Nephrology
- Public Health
Background:
- Risk assessment for mortality and end-stage renal disease (ESRD) in elderly patients with chronic kidney disease (CKD) is increasingly important.
- Current approaches often lack integration of risk equations into a multidimensional assessment for elderly patients with CKD stages 3b-4.
Purpose of the Study:
- To evaluate the utility of risk stratification tools and comprehensive geriatric assessment (CGA) in elderly patients with advanced CKD.
- To compare predicted outcomes with actual clinical endpoints in this population.
Main Methods:
- Prospective observational study of 184 patients aged ≥65 years with CKD stage 3b-4.
- Application of the Bansal score for mortality risk and the Kidney Failure Risk Equation (KFRE) for ESRD progression.
- All participants underwent comprehensive geriatric assessment (CGA).
Main Results:
- High-risk group (Bansal score ≥7) showed significantly higher cardiovascular disease burden, depression, and malnutrition risk compared to the low-risk group (Bansal score <7).
- The high-risk group had significantly higher all-cause mortality (HR=3.96, P<0.001) and higher rates of dialysis initiation.
- Two-thirds of the elderly CKD patients were identified as high-risk for mortality, malnutrition, and depression.
Conclusions:
- Risk stratification tools combined with CGA effectively identify elderly patients with advanced CKD at high risk for adverse outcomes.
- Elderly patients with advanced CKD stratified as high-risk face a fourfold worse survival probability and increased risk of dialysis.
- Multidimensional assessment is crucial for managing elderly CKD patients, highlighting significant unmet needs in this population.
Background:
Risk assessment tools for predicting mortality and end-stage renal disease (ESRD) in the elderly with CKD have received growing attention. However, integrating risk equations into a multidimensional approach of elderly with CKD stage 3b-4 is lacking.
Methods:
In this prospective observational study, we enrolled CKD stage 3b-4 patients aged ≥ 65 years. Bansal score for predicting mortality risk and Kidney Failure Risk Equation (KFRE) for estimating progression to ESRD were applied. Predicted outcome was compared with actual clinical end-points. All patients underwent comprehensive geriatric assessment (CGA), which is an interdisciplinary multidimensional process for geriatric evaluation and management.
Results:
Participants (N = 184) were divided into two groups, according to Bansal score: Group 1 (low-risk of death, Bansal score < 7, N = 69) and Group 2 (high-risk of death, Bansal score ≥ 7, N = 115). Group 2 displayed a substantially higher cardiovascular disease burden than Group 1 and was significantly more likely to be depressed and at risk of malnutrition, according to CGA. Thirty-seven patients died, and 16 started dialysis. Group 2 displayed significantly higher all-cause mortality. In the univariable Cox regression, Group 2 had a fourfold increase in the risk of all-cause mortality, as compared with Group 1 (HR = 4.29, 95% CI 1.88-10.26, P < 0.001). Multivariable stepwise Cox analysis showed that Bansal score above 7 remained significantly associated with all-cause mortality (HR = 3.96, 95% CI 1.68-9.29, P < 0.001). Group 2 also displayed higher event rates for dialysis initiation. In Group 1, only four patients started dialysis, and three out of them had a high-risk of progression at baseline, according to KFRE.
Conclusions:
Using risk stratification tools and CGA in a population of elderly with advanced CKD, we found that two-thirds of the patients were at high risk of death, malnutrition and depression, with multimorbidity and four times worse probability of survival than those at lower risk of death.
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