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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Nephrology 1/2016

External Validation of a risk stratification model to assist shared decision making for patients starting renal replacement therapy

Zeitschrift:
BMC Nephrology > Ausgabe 1/2016
Autoren:
Patrick Peeters, Wim Van Biesen, Nic Veys, Wim Lemahieu, Bart De Moor, Johan De Meester
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12882-016-0253-3) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

PP analysed and cleaned the database and contributed to writing and correcting the paper. WVB conceived the study, analysed the data and contributed to writing and correcting the paper. NV contributed to writing and correcting the paper and setting up the registry. WL analysed the data and contributed to writing and correcting the paper. BDM analysed the data and contributed to writing and correcting the paper. JDM was responsible for setting up the database, analysed the data and contributed to writing and correcting the paper. All authors read and approved the final manuscript.

Abstract

Background

Shared decision making is nowadays acknowledged as an essential step when deciding on starting renal replacement therapy. Valid risk stratification of prognosis is, besides discussing quality of life, crucial in this regard. We intended to validate a recently published risk stratification model in a large cohort of incident patients starting renal replacement therapy in Flanders.

Methods

During 3 years (2001–2003), the data set collected for the Nederlandstalige Belgische Vereniging voor Nefrologie (NBVN) registry was expanded with parameters of comorbidity. For all incident patients, the abbreviated REIN score(aREIN), being the REIN score without the parameter “mobility”, was calculated, and prognostication of mortality at 3, 6 and 12 month after start of renal replacement therapy (RRT) was evaluated.

Results

Three thousand four hundred seventy-two patients started RRT in Flanders during the observation period (mean age 67.6 ± 14.3, 56.7 % men, 33.6 % diabetes). The mean aREIN score was 4.1 ± 2.8, and 56.8, 23.1, 12.6 and 7.4 % of patients had a score of ≤4, 5–6, 7–8 or ≥9 respectively. Mortality at 3, 6 and 12 months was 8.6, 14.1 and 19.6 % in the overall and 13.2, 21.5 and 31.9 % in the group with age >75 respectively. In RoC analysis, the aREIN score had an AUC of 0.74 for prediction of survival at 3, 6 and 12 months. There was an incremental increase in mortality with the aREIN score from 5.6 to 45.8 % mortality at 6 months for those with a score ≤4 or ≥9 respectively.

Conclusion

The aREIN score is a useful tool to predict short term prognosis of patients starting renal replacement therapy as based on comorbidity and age, and delivers meaningful discrimination between low and high risk populations. As such, it can be a useful instrument to be incorporated in shared decision making on whether or not start of dialysis is worthwhile.
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