Abstract
BackgroundShared 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.MethodsDuring 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.ResultsThree 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.ConclusionThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0253-3) contains supplementary material, which is available to authorized users.
Highlights
Shared decision making is nowadays acknowledged as an essential step when deciding on starting renal replacement therapy
Existing literature indicates that mere age on itself is insufficient to prognosticate outcome after start of renal replacement therapy (RRT), and that rather presence of comorbidities should be taken into account [7,8,9]
Baseline information at dialysis initiation included age, gender, estimated glomerular filtration rate (eGFR) based on creatinine and the modification of diet in renal disease (MDRD) formula, body mass index (BMI), serum albumin the month preceding dialysis start, diabetes, congestive heart failure (New York Heart Association stages I to IV), ischaemic heart disease, peripheral vascular disease (Leriche classification stages I to IV), cerebrovascular disease, arrhythmia, chronic obstructive pulmonary disease (COPD), malignancy, liver cirrhosis, mental disorders, initial dialysis modality, and late referral
Summary
Shared decision making is nowadays acknowledged as an essential step when deciding on starting renal replacement therapy. Whereas start of renal replacement therapy can be lifesaving, it is associated with a high short term mortality and a substantial decrease in quality of life for some patients [2, 3]. In this setting, there is an increasing interest for the concept of conservative care [4,5,6], as it is accepted that for some patients the benefits of starting renal replacement therapy do not outweigh the drawbacks. Studies indicate that physicians tend to be overly optimistic on the prognosis of their patients [10]. Such a failure to recognise a poor prognosis might lead to perseveration of therapy and overemphasis of cure rather than care [5, 11] and deprive patients from achieving a good and serene death [4]
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