Risk prediction for death and end-stage renal disease does not parallel the real-life trajectory of older patients with advanced chronic kidney disease – a Romanian center experience.

Abstract

IntroductionIn 2016, the European Renal Best Practice (ERBP) group published a guideline on the management of older adults with advanced chronic kidney disease (CKD). Two risk scores were highlighted: Bansal score for mortality, and Kidney Failure Risk Equation (KFRE) for estimating progression to end-stage kidney disease (ESRD). Our group, as part of the ERBP team, aimed to apply these risk prediction tools in a cohort of older adults with eGFR <45 ml/min/1.73 m2.Material and methodsThis retrospective study included adults aged ≥65 years with CKD stage 3b-4, evaluated at a Romanian Outpatient Nephrology Department between October 2016 – October 2018. Bansal score was calculated for all subjects and then KFRE was used in the low mortality risk group. Outcomes were death or reaching ESRD. These outcomes were used to compare the difference between the estimated trajectory and real-life trajectory of patients. They were followed up until September 2019.ResultsFrom the total population (N=958 patients), more than half (N1=548, 57.2%) had a high mortality risk. In the remaining group with low mortality risk (N2=410, 42.8%), a significant percentage (75.4%) presented a low risk of progression to ESRD. Real-life events consisted of 164 deaths and 31 dialysis initiations. We found similar death rates in the two groups (high versus low risk of mortality). There was no difference in the rate of dialysis initiation between subjects with a high or low risk of progression to ESRD.ConclusionsRisk prognostication for death and ESRD did not parallel the real-life trajectory of our older patients with advanced CKD.