Abstract
It has been reported that the survival of hemodialysis (HD) patients is poor, and the leading cause of death is cardiovascular disease. To identify high-risk patients and treat them carefully, we developed a scoring system to evaluate their 15-year prognosis in a prospective cohort study. We analyzed data from 312 and 310 patients to develop and validate the prediction model, respectively. The association of potential risk factors with death was tested by Cox proportional-hazards analysis, and a risk scoring model was developed. Then, the model was validated. Two hundred patients (64.1 %) in the cohort for model development died. Six independent prognostic factors were retained in the final model, and each was assigned a score proportional to its regression coefficient: 65 years or older, 3; diabetic nephropathy, 3; hypotension, 1; pre-HD cardiothoracic ratio ≥50 %, 1; pre-HD BNP ≥250 pg/mL, 1; and pre-HD numbers of abnormal findings on electrocardiograms = 0, 1, 2, or larger, 0, 1, 5. The patients were categorized as follows with their scores: group 1 (low risk), 0; group 2, 1 to 3; group 3, 4 to 5; and group 4 (high risk), 6 and higher. In the cohort for model validation, groups 2 to 4 showed a higher risk than group 1: group 2, hazard ratio 4.66 (95 % confidence interval 2.25, 9.64); group 3, 13.62 (6.48, 28.63); and group 4, 20.86 (9.60, 45.31). A new risk scoring system for predicting 15-year mortality was developed. This system may be useful for evaluating HD patients’ prognosis.
Highlights
It has been reported that the survival of hemodialysis (HD) patients is poor, and the leading cause of death is cardiovascular disease
The number of patients on maintenance hemodialysis (HD) has been rapidly increasing over the last decades [1], and more than 320,000 patients are on maintenance HD in Japan at the end of 2014 [2]
To evaluate HD patients’ prognosis and find patients with high risk of death, there is a need for novel index that is based on the cardiac disorder parameters
Summary
It has been reported that the survival of hemodialysis (HD) patients is poor, and the leading cause of death is cardiovascular disease. To identify high-risk patients and treat them carefully, we developed a scoring system to evaluate their 15-year prognosis in a prospective cohort study. The number of patients on maintenance hemodialysis (HD) has been rapidly increasing over the last decades [1], and more than 320,000 patients are on maintenance HD in Japan at the end of 2014 [2]. There were few papers that reported the impact of cardiac and/or circulatory disorder parameters, which are routinely measured along with vital signs during HD treatment, on long-term prognosis. To evaluate HD patients’ prognosis and find patients with high risk of death, there is a need for novel index that is based on the cardiac disorder parameters. We conducted a long-term prospective multicenter cohort study to establish a prediction model for mortality in maintenance HD patients using not specific parameters but clinically easy to measure parameters
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