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Predicting 3-month and 1-year mortality for patients initiating dialysis: a population-based cohort study

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Abstract

Background

Despite the continual improvements in dialysis treatments, mortality in end-stage kidney disease (ESKD) remains high. Many mortality prediction models are available, but most of them are not precise enough to be used in the clinical practice. We aimed to develop and validate two prediction models for 3-month and 1-year patient mortality after dialysis initiation in our population.

Methods

Using population-based data of insurance claims in Taiwan, we included more than 210,000 patients who initiated dialysis between January 1, 2006, and June 30, 2015. We developed two prognostic models, which included 9 and 11 variables, respectively (including age, sex, myocardial infarction, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, peptic ulcer disease, malignancy, moderate to severe liver disease, and first dialysis in intensive care unit).

Results

The models showed adequate discrimination (C-statistics were 0.80 and 0.82 for 3-month and 1-year mortality, respectively) and good calibration. In both our models, the first dialysis in the intensive care unit and moderate-to-severe liver disease were the strongest risk factors for mortality.

Conclusion

The prediction models developed in our population had good predictive ability for short-term mortality in patients initiating dialysis in Taiwan and could help in decision-making regarding dialysis initiation, at least in our setting, supporting a patient-centered approach to care.

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Funding

This study was supported by grants from the National Health Research Institutes (NHRI-EX109-10926HT) and Ministry of Science and Technology (MOST) (MOST109-2314-B-038-106-MY3).

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Mei-Yi Wu, Yu-Wei Chen & Mai-Szu Wu

  2. TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan

    Mei-Yi Wu, Yu-Wei Chen & Mai-Szu Wu

  3. Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Mei-Yi Wu & Mai-Szu Wu

  4. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Mei-Yi Wu & Tzu-Ting Chen

  5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan

    Ping-Jen Hu

  6. Division of Gastroenterology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Ping-Jen Hu

  7. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yu-Wei Chen & Mai-Szu Wu

  8. Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Li-Chin Sung

  9. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Li-Chin Sung

  10. Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Li-Chin Sung

  11. Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan

    Tzu-Ting Chen

  12. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan

    Yih-Giun Cherng

  13. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yih-Giun Cherng

Authors
  1. Mei-Yi Wu
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  2. Ping-Jen Hu
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  3. Yu-Wei Chen
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  4. Li-Chin Sung
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  5. Tzu-Ting Chen
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  6. Mai-Szu Wu
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  7. Yih-Giun Cherng
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Contributions

Mei-Yi Wu, Ping-Jen Hu, Yu-Wei Chen, Tzu-Ting Chen, Mai-Szu Wu and Yih-Giun Cherng contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mei-Yi Wu, Ping-Jen Hu, Yu-Wei Chen, Li-Chin Sung and Tzu-Ting Chen. The first draft of the manuscript was written by Mei-Yi Wu, Ping-Jen Hu, Yu-Wei Chen, Li-Chin Sung, Tzu-Ting Chen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yih-Giun Cherng.

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Wu, MY., Hu, PJ., Chen, YW. et al. Predicting 3-month and 1-year mortality for patients initiating dialysis: a population-based cohort study. J Nephrol 35, 1005–1013 (2022). https://doi.org/10.1007/s40620-021-01185-w

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  • DOI: https://doi.org/10.1007/s40620-021-01185-w

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