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Low performance of prognostic tools for predicting death before dialysis in older patients with advanced CKD

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Abstract

Introduction

Chronic kidney disease (CKD) is a disease which is spreading worldwide, especially among older patients. Several prognostic scores have been developed to predict death in older CKD patients, but they have not been validated. We aimed to evaluate the existing risk scores for predicting death before dialysis start, identified via an in-depth review, in a cohort of elderly patients with advanced CKD.

Methods

We performed a review to identify scores predicting death, developed in and applicable to CKD patients. Each score was evaluated with an absolute risk calculation from the patients’ baseline characteristics. We used a French prospective multicentre cohort of elderly patients (> 75 years) with advanced CKD [estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m2], recruited from nephrological centres, with a 5-year follow-up. The outcome considered was death before initiating dialysis. Discrimination [area under curve (AUC)], calibration and Brier score were calculated for each score at its time frame.

Results

Our review found 6 equations predicting death before dialysis in CKD patients. Four of these (GOLDFARB, BANSAL, GRAMS 2 and 4 years) were evaluated. The validation cohort (Parcours de Soins des Personnes Âgées Parcours de Soins des Personnes Âgées, PSPA) included 573 patients, with a median age of 82 years and a median eGFR of 13 mL/min/1.73 m2. At the end of follow-up, 287 (50%) patients had started dialysis and 238 (41%) patients had died before dialysis. The four equations evaluated showed average discrimination (AUC 0.61–0.70) and, concerning calibration, a global overestimation of the risk of death.

Discussion

The available scores predicting death before dialysis showed low performance among older patients with advanced CKD in a French multicentre cohort, indicating the need to upgrade them or develop new scores for this population.

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Abbreviations

AUC:

Area under curve

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

ESRD:

End stage renal disease

IQ:

Interquartile

KDIGO:

Kidney disease improving global outcome

MDRD:

Modification of diet in renal disease (mL/min/1.73 m2)

PSPA:

Parcours de Soins des Personnes Âgées

REIN:

Réseau Epidémiologique et Information en Néphrologie

RRT:

Renal replacement therapy

TRIPOD:

Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis

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Acknowledgements

We also thank Teresa Sawyers, British Medical Writer at the B.E.S.P.I.M. for her help with revising the manuscript.

Collaborators: Heads of departments, investigators (French centers) that participated in the study: Y. Lemeur (Chu Brest), T. Lobbedez (CHU Caen), C. Passeron (CH Cannes), A. Djema (CH Cholet), M. Matignon (APHP, Creteil), P. Zaoui (CHU Grenoble), I. Farah (CH Le Mans), E. Boulanger (CHU Lille), V. Allot (CHU Limoges), S. Roche (CH Macon), J. Sampol (Clinique Bouchard, Marseille), D. Babici (CH Mulhouse), O. Moranne (CHU Nice), M. Souid (CH Poissy), F. Bridoux (CHU Poitiers), C. Vigneau (CHU Rennes), J. Potier (CH St Brieuc), C. Mariat (CHU St Etienne), E. Renaudineau (CH Saint Malo), S. Roueff (CH Saint Maurice), A. Kolko-Labadens (Hopital Foch), M. Francois (CHU Tours), L. Vrigneaud, D. Fleury (CH Valenciennes) and Didier Aguile´ra (CH Vichy).

Funding

Research Grant from La Société Francophone de Nephrologie et de Dialyse (2014). Research Grant from La Société Française de Néphrologie Dialyse Transplantation (2018). Research Grant from l’Agence de Biomedecine (2009 and 2012). We thank Nîmes University Hospital for its structural, human, and financial support through the award obtained by our team during the internal call for tenders “Thématiques émergentes”.

Author information

Authors and Affiliations

  1. IDESP, INSERM Université de Montpellier, Montpellier, France

    Julien Prouvot, Valery Antoine & Olivier Moranne

  2. Service Néphrologie-Dialyses-Aphérèses, Hôpital Universitaire de Nîmes, CHU Caremeau, Place du Pr Debré, 30000, Nimes, France

    Julien Prouvot, Emilie Pambrun, Camelia Prelipcean & Olivier Moranne

  3. Service de Gériatrie, Hôpital Universitaire de Nîmes, Nimes, France

    Valery Antoine

  4. Registre REIN, Agence de la Biomedecine, Saint-Denis La Plaine, France

    Cecile Couchoud

  5. CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Villeurbanne, France

    Cecile Couchoud

  6. CHU Pontchaillou, Service de Néphrologie-Dialyse-Transplantation, Université Rennes 1, IRSET, Rennes, France

    Cecile Vigneau

  7. Service de Nephrologie‑Dialyse, CH Macon, Macon, France

    Sophie Roche

  8. Service de Néphrologie-Dialyse-Transplantation, CHU Tours, Tours, France

    Maud Francois

  9. Service de Néphrologie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Étienne, 42055, Saint-Étienne Cedex 02, France

    Christophe Mariat

  10. Service Néphrologie-Dialyse, GHR MSA, Hôpital Emile Muller, Mulhouse, France

    Daniela Babici

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  1. Julien Prouvot
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  2. Emilie Pambrun
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  11. Olivier Moranne
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Consortia

For the PSPA Investigators

  • Y. Lemeur
  • , T. Lobbedez
  • , C. Passeron
  • , A. Djema
  • , M. Matignon
  • , P. Zaoui
  • , I. Farah
  • , E. Boulanger
  • , V. Allot
  • , S. Roche
  • , J. Sampol
  • , D. Babici
  • , O. Moranne
  • , M. Souid
  • , F. Bridoux
  • , C. Vigneau
  • , J. Potier
  • , C. Mariat
  • , E. Renaudineau
  • , S. Roueff
  • , A. Kolko-Labadens
  • , M. Francois
  • , L. Vrigneaud
  • , D. Fleury
  •  & Didier Aguilera

Corresponding author

Correspondence to Olivier Moranne.

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The authors declare no conflicts of interest.

Statement of Ethics

This study was approved by the Agence Nationale de Sécurité du Médicament et des produits de santé – RCB-2018-A03347-48) and also an independent Ethics committee (CCP-V Ouest, Rennes). It was conducted according to the declaration of Helsinki and all patients provided written informed consent.

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Prouvot, J., Pambrun, E., Antoine, V. et al. Low performance of prognostic tools for predicting death before dialysis in older patients with advanced CKD. J Nephrol 35, 993–1004 (2022). https://doi.org/10.1007/s40620-021-01180-1

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  • DOI: https://doi.org/10.1007/s40620-021-01180-1

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