Model predicts dialysis patients' likelihood of survival

Dec 03, 2009
This is a picture of Michael Germain, M.D., co-author of the study. Credit: none

A new model can help physicians determine if a kidney disease patient on dialysis is likely to die within the next few months, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). This clinical tool could help medical professionals initiate discussions with patients and their families about end-of-life care such as hospice.

Some kidney disease patients on dialysis are very ill and long-term survival is not anticipated. Because dialysis can be tedious and cause medical complications, patients who know that they likely have only a short time to live may wish to consider alternatives such as stopping dialysis. Unfortunately, doctors have not had accurate ways to predict dialysis patients' likelihood of long-term survival.

Michael Germain, MD; Lewis Cohen, MD (Baystate Medical Center); and their colleagues designed a model to help physicians assess the likelihood of long-term survival for these very ill patients. The investigators derived their model after studying 512 kidney disease patients on dialysis. One major component of the model is a doctor's estimate of prognosis, called the "surprise question." (Would you be surprised if your patient died in the next six months?) The model also takes into consideration a patient's nutritional status, age, and additional illnesses or conditions.

Five simple factors: a 'no' answer to the surprise question, older age, decreased serum albumin, presence of , and presence of peripheral vascular disease (blockage of an artery that leads to an arm or a leg), could be mathematically combined to accurately predict that a patient is unlikely to survive past six months. When comparing a patient who died within six months with one who remained alive, 87% of the time the model accurately predicted that the former patient had a higher risk of dying within that timeframe than the latter. The researchers validated their model by testing its accuracy in another 514 kidney disease patients on dialysis, where the model's predictive accuracy was only slightly lower (80%).

Discussing a patient's likelihood of dying can help seriously ill patients and their families make informed clinical decisions: some will decide to stop and start hospice care, while others may prefer continuing vigorous treatments to prolong life as long as possible. "Terminal care is complicated and it is always preferable if decisions can be discussed in advance, goals established, and decisions reached collaboratively between patient and physician," said Dr. Germain.

More information: The article, entitled "Predicting Six-Month Mortality in Patients Maintained with Hemodialysis," will appear online on December 3, 2009, doi:10.2215/CJN.03860609

Source: American Society of Nephrology (news : web)

Explore further: Saudi Arabia: Deaths from MERS virus reach 348

add to favorites email to friend print save as pdf

Related Stories

The cost of improving dialysis care

Nov 02, 2009

Improving survival among dialysis patients may increase treatment costs significantly, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, ...

Sleeping through dialysis: No nightmare for kidney patients

May 21, 2009

Dialysis takes hours of kidney disease patients' time several days a week, so why not do it at night while sleeping? Overnight dialysis is more convenient for some patients and offers significant benefits over shorter daytime ...

Hello wearable kidney, goodbye dialysis machine

Aug 20, 2009

Researchers are developing a Wearable Artificial Kidney for dialysis patients, reports an upcoming paper in the Clinical Journal of the American Society of Nephrology (CJASN). "Our vision of a technological breakthrough ...

Dialysis safe for kidney patients' heart health

Jul 09, 2009

Dialysis treatments do not affect the heart health of kidney disease patients who have had a heart attack, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN ...

Recommended for you

Ebola isolation at US base 'pretty much vacation'

15 hours ago

With plenty of flat screen TVs, game nights and even an outdoor fire pit, life in isolation for members of the U.S. military who have returned from the Ebola mission in West Africa can look a lot like summer ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.