Abstract
Abstract Background and Aims Elderly patients with Advanced Chronic Kidney Disease (ACKD) present high cardiovascular comorbidity and increased mortality risk. The CKD-G4+ risk calculator was developed by Grams specifically for the population with CKD G4 and analyzes the risk of requiring kidney replacement therapy (KRT), cardiovascular events and death. Ours aims was validation of the Grams score as a prognostic tool in patients with CKD G4 aged over 65 years old in our hospital area. Method Descriptive and retrospective non-randomized study of a cohort of patients older than 65 years with CKD G4 attending for the first time for consultation during 2016 and 2017. Follow-up for 4 years or first clinical event defined as need for KRT, eGFR < = 8 ml/min/1.72 m2 or death. Demographic and clinical data were collected for Grams model risk calculation (age, sex, CKD-EPI eGFR, urine albumin/creatinine ratio (CAC), systolic blood pressure (SBP), diabetes, smoking, cardiovascular history, non-fatal cardiovascular event (CHF, AMI, stroke) and death). SPSS statistical analysis. Results Of 663 patients who started follow-up in ACKD consultations in our hospital area between 2016 and 2017, 303 patients who met inclusion criteria were analyzed, 31 were excluded due to loss to follow-up. The clinical characteristics of the studied population are collected in Table 1. The results are collected in Table 2, they include predicted and observed incidences of death, KRT onset and cardiovascular events in 2 and 4 years from the first visit. Predictors used in this study included Grams calculator risk scores at 2 and 4 years (Grams-2 and Grams-4,respectively) for any KRT, cardiovascular events, and death. Conclusion In our cohort of patients with G4 ACKD older than 65 years old, the Grams score provides good discrimination to significantly predict the onset of KRT and cardiovascular events. The risk of death was moderately accurate and should be taken into account for care planning. Further external validation studies are required.
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