Background: Adults over 70 years old are the fastest growing segment of the end stage renal disease (ESRD) population. Due to substantial variation in co-morbidities and life expectancy in this group, we sought to develop a clinical prediction tool to identify incident elderly dialysis patients (age≥70) with a 5-year prognosis appropriate for kidney transplantation.

Methods: We used data from the United States Renal Data System. All incident dialysis patients in 2006-2009 aged ≥70 at the time of dialysis initiation were included. Patients who were transplanted, missing dialysis start date or recovered renal function were excluded. Included patients were randomly divided into derivation and validation cohorts. Using the derivation cohort, candidate variables with significant crude association with 5-year all-cause mortality were included in a multivariate model which was used to generate a scoring system based on the beta coefficients. The scoring system was then applied to the validation cohort for performance testing.

Results: The relevant variables and score assignments, derived from the derivation cohort (n=78,595), are shown below. In the validation cohort (n=78,596), the probability of mortality within 5 years of dialysis initiation was 52.6% for the lowest risk score quintile (<1pt) representing 3.4% of the validation cohort.

Conclusions: Our clinical prediction tool could be useful for physicians to identify potentially suitable candidates for kidney transplantation among elderly dialysis patients in the US.

CITATION INFORMATION: Chen L.-X, Josephson M, Stankus N, Campbell K, Hedeker D, Saunders M. Clinical Prediction Tool to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation. Am J Transplant. 2016;16 (suppl 3).

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