Short-term prognostic score for very elderly patients, aged 85 or older, initiating hemodialysis

As the population ages, factors affecting prognosis after dialysis initiation in very elderly patients remain unclear. We aimed to develop a prognostic score to predict short-term survival in this group.

This retrospective cohort study included 116 patients aged 85 or older who initiated hemodialysis at our hospital between 2010 and 2023, out of a total of 2279 patients. Using a Cox regression model, we analyzed factors affecting 3-year all-cause mortality. Based on these analyses, a prognostic scoring system was developed to predict patient outcomes.

Baseline factors independently associated with mortality (hazard ratio (HR), 95% confidence interval (CI)) included body mass index (BMI) < 18.5 (2.14, 1.17-3.91), cardiovascular disease (2.16, 1.10-4.22), advanced cancer (4.65, 1.73-12.5), impaired walking (2.33, 1.17-4.64), emergency dialysis without fistula (1.88, 1.03-3.44), fluid overload (2.70, 1.43-5.07), serum albumin < 3.0 g/dL (2.32, 1.25-4.32), and C reactive protein (CRP) > 0.5 mg/dL (3.87, 1.85-8.10). A scoring system was developed, assigning 1 point each for BMI < 18.5, cardiovascular disease, impaired ambulation, emergency dialysis without fistula, fluid overload, and serum albumin < 3.0 g/dL, and 2 points for advanced cancer and CRP > 0.5 mg/dL. The score demonstrated an area under the ROC curve of 0.83. The hazard ratios for 3-year mortality for scores of 4-5 and 6 or higher, compared to 0-3, were 2.55 (95% CI: 1.04-6.23) and 7.10 (3.36-15.0), respectively (P for trend < 0.001). Subgroup analyses confirmed the score's robustness.

The prognostic score for 3-year mortality in very elderly patients who initiate dialysis should be validated in different populations and is expected to inform decisions regarding dialysis initiation.