Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients
Aplicabilidad clínica de dos índices pronósticos de mortalidad precoz en pacientes añosos incidentes en hemodiálisis: escaso acierto predictivo en el paciente individual
Read
13949
Timeswas read the article
2982
Total PDF
10967
Total HTML
Share statistics
array:21 [ "pii" => "X2013251412000891" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Dec.11159" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:213-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7742 "formatos" => array:3 [ "EPUB" => 315 "HTML" => 6668 "PDF" => 759 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699512000894" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.Dec.11159" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2012;32:213-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10791 "formatos" => array:3 [ "EPUB" => 281 "HTML" => 9792 "PDF" => 718 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Aplicabilidad clínica de dos índices pronósticos de mortalidad precoz en pacientes añosos incidentes en hemodiálisis: escaso acierto predictivo en el paciente individual" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213" "paginaFinal" => "220" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_108_24088_es_11159_t1.jpg" "Alto" => 215 "Ancho" => 600 "Tamanyo" => 110659 ] ] "descripcion" => array:1 [ "es" => "Índice pronóstico del registro francés REIN" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. del Sol Otero-López, Juan C. Martínez-Ocaña, Loreley Betancourt-Castellanos, Eleonora Rodríguez-Salazar, Manuel García-García" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M. del Sol" "apellidos" => "Otero-López" ] 1 => array:2 [ "nombre" => "Juan C." "apellidos" => "Martínez-Ocaña" ] 2 => array:2 [ "nombre" => "Loreley" "apellidos" => "Betancourt-Castellanos" ] 3 => array:2 [ "nombre" => "Eleonora" "apellidos" => "Rodríguez-Salazar" ] 4 => array:2 [ "nombre" => "Manuel" "apellidos" => "García-García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251412000891" "doi" => "10.3265/Nefrologia.pre2011.Dec.11159" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000891?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000894?idApp=UINPBA000064" "url" => "/02116995/0000003200000002/v0_201502091353/X0211699512000894/v0_201502091354/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251412000883" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Jan.10946" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:221-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5808 "formatos" => array:3 [ "EPUB" => 297 "HTML" => 4791 "PDF" => 720 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Use of methoxy polyethylene glycol-epoetin beta in stage 3, 4 or 5 non-dialysis chronic kidney disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "227" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilización de eritropoyetina beta pegilada en enfermedad renal crónica en estadio 3, 4 o 5 no-D" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10946_16025_28198_en_f1_109462.jpg" "Alto" => 992 "Ancho" => 600 "Tamanyo" => 216800 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with haemoglobin above 12g/dl" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Núria Padullés-Zamora, Dolors Comas-Sugrañes, M. del Mar Pineda-Yuste, Ramon Jódar-Masanés, Alberto Martínez-Castelao" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Núria" "apellidos" => "Padullés-Zamora" ] 1 => array:2 [ "nombre" => "Dolors" "apellidos" => "Comas-Sugrañes" ] 2 => array:2 [ "nombre" => "M. del Mar" "apellidos" => "Pineda-Yuste" ] 3 => array:2 [ "nombre" => "Ramon" "apellidos" => "Jódar-Masanés" ] 4 => array:2 [ "nombre" => "Alberto" "apellidos" => "Martínez-Castelao" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512000886" "doi" => "10.3265/Nefrologia.pre2012.Jan.10946" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000886?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000883?idApp=UINPBA000064" "url" => "/20132514/0000003200000002/v0_201502091616/X2013251412000883/v0_201502091617/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251412000906" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Dec.11223" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:206-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11240 "formatos" => array:3 [ "EPUB" => 305 "HTML" => 10038 "PDF" => 897 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Congestive heart failure in patients with advanced chronic kidney disease: association with pre-emptive vascular access placement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "206" "paginaFinal" => "212" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Insuficiencia cardíaca en la enfermedad renal crónica avanzada: relación con el acceso vascular" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11223_16025_27344_en_t111223en.jpg" "Alto" => 1959 "Ancho" => 2170 "Tamanyo" => 1348742 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory parameters for all patients and each sub-group according to the presence or absence of congestive heart failure" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Martínez Gallardo, Rocío Martínez-Gallardo, Flavio Ferreira Morong, Flavio Ferreira-Morong, Guadalupe García Pino, Guadalupe García-Pino, Isis Cerezo Arias, Isis Cerezo-Arias, Román Hernández Gallego, Román Hernández-Gallego, Francisco Caravaca Magariños" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Rocío" "apellidos" => "Martínez Gallardo" ] 1 => array:2 [ "nombre" => "Rocío" "apellidos" => "Martínez-Gallardo" ] 2 => array:2 [ "nombre" => "Flavio" "apellidos" => "Ferreira Morong" ] 3 => array:2 [ "nombre" => "Flavio" "apellidos" => "Ferreira-Morong" ] 4 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "García Pino" ] 5 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "García-Pino" ] 6 => array:2 [ "nombre" => "Isis" "apellidos" => "Cerezo Arias" ] 7 => array:2 [ "nombre" => "Isis" "apellidos" => "Cerezo-Arias" ] 8 => array:2 [ "nombre" => "Román" "apellidos" => "Hernández Gallego" ] 9 => array:2 [ "nombre" => "Román" "apellidos" => "Hernández-Gallego" ] 10 => array:2 [ "nombre" => "Francisco" "apellidos" => "Caravaca Magariños" ] 11 => array:2 [ "nombre" => "Francisco" "apellidos" => "Caravaca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512000909" "doi" => "10.3265/Nefrologia.pre2011.Dec.11223" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512000909?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000906?idApp=UINPBA000064" "url" => "/20132514/0000003200000002/v0_201502091616/X2013251412000906/v0_201502091617/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Two prognostic scores for early mortality and their clinical applicability in elderly patients on haemodialysis: poor predictive success in individual patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213" "paginaFinal" => "220" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. del Sol Otero-López, Juan C. Martínez-Ocaña, Loreley Betancourt-Castellanos, Eleonora Rodríguez-Salazar, Manuel García-García" "autores" => array:5 [ 0 => array:3 [ "nombre" => "M. del Sol" "apellidos" => "Otero-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Juan C." "apellidos" => "Martínez-Ocaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Loreley" "apellidos" => "Betancourt-Castellanos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Eleonora" "apellidos" => "Rodríguez-Salazar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:4 [ "nombre" => "Manuel" "apellidos" => "García-García" "email" => array:1 [ 0 => "mgarcia@tauli.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de Sabadell. Corporació Sanitària i Universitària Parc Taulí-Universidad Autónoma de Barcelona, Sabadell, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aplicabilidad clínica de dos índices pronósticos de mortalidad precoz en pacientes añosos incidentes en hemodiálisis: escaso acierto predictivo en el paciente individual" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27314_en_t1_11159i.jpg" "Alto" => 755 "Ancho" => 2176 "Tamanyo" => 479065 ] ] "descripcion" => array:1 [ "en" => "Prognostic index developed by the French registry REIN" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Chronic kidney disease (CKD) is very prevalent in the elderly population. In fact, more than 40% of patients initiating chronic dialysis in Catalonia are more than 70 years old.<span class="elsevierStyleSup">1</span> The peak incidence rate is among patients older than 75 in the United States,<span class="elsevierStyleSup">2</span> and as a result, increasing numbers of octogenarians and nonagenarians are starting dialysis.<span class="elsevierStyleSup">3</span> On the other hand, the elderly population tends to suffer from other chronic diseases which worsen short term vital and functional prognoses, particularly in individuals who were already unable to perform basic daily activities unaided.<span class="elsevierStyleSup">4</span> The above considerations raise a debate over the theoretical benefit of chronic dialysis and its drawbacks in terms of the complications and reduced quality of life for elderly patients with multiple co-morbidities and advanced stages of CKD.<span class="elsevierStyleSup">5-7</span> It would therefore be useful to have access to the best possible prognosis predictors in order to make the right decision for the patient.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">Several co-morbidity scores have been used in order to estimate the prognosis of CKD, such as those created by Charlson,<span class="elsevierStyleSup">9</span> Khan,<span class="elsevierStyleSup">10</span> Davies,<span class="elsevierStyleSup">11</span> Liu,<span class="elsevierStyleSup">12</span> and the modified Charlson index<span class="elsevierStyleSup">13</span>; the latter probably being the most commonly used and recommended for CKD.<span class="elsevierStyleSup">14,15</span> Although these scores are useful for comparing co-morbidity in different groups or populations, they are not particularly effective in determining individual prognoses. In addition, other factors including age, sex, primary kidney disease, type of treatment or starting dialysis on an unplanned, emergency basis may significantly influence mortality in these patients.<span class="elsevierStyleSup">16,17</span></p><p class="elsevierStylePara">Some individual prognostic models were published recently for elderly patients starting dialysis,<span class="elsevierStyleSup">18</span> haemodialysis (HD),<span class="elsevierStyleSup">19</span> and prevalent patients already undergoing HD.<span class="elsevierStyleSup">20</span> These prognostic models for incident patients on dialysis draw on a wide array of clinical and demographic variables, and they were elaborated after analysing databases containing thousands of patients from the French and Catalan kidney replacement therapy registries, the <span class="elsevierStyleItalic">Renal Epidemiology and Information Network</span><span class="elsevierStyleItalic"> </span>(<span class="elsevierStyleItalic">Réseau Epidémiologie et Information en Néphrologie</span> or REIN)<span class="elsevierStyleSup">18</span> and the <span class="elsevierStyleItalic">Registre de Malalts Renals de Catalunya </span><span class="elsevierStyleItalic">(</span><span class="elsevierStyleItalic">Catalan Registry of Renal Patients</span> or RMRC).<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara">The aim of our study was to evaluate the clinical usefulness of the REIN prognostic index (REIN score) and the Catalan registry's predictive index for early mortality (RMRC) by comparing them with individual mortality rates observed in a cohort of elderly patients who started HD and continued their treatment in a hospital nephrology department. If these models were valid in clinical practice, they would be useful tools for helping decide whether or not KRT should be indicated in these patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Observational, retrospective, comparative study of different individual prognostic indices for early mortality in patients 75 years of age and older who began chronic HD treatment in Hospital de Sabadell between 2004 and 2009. The nephrology department provides care to a population of 429 000 inhabitants and offers different alternatives for the initial management of end-stage chronic renal failure (ESCRF): conservative treatment, kidney transplant, peritoneal dialysis and HD. We excluded patients referred to other centres and those treated with peritoneal dialysis. Figure 1 shows clinical management details for our ESCRF patients. Of a total of 437 patients, 13% underwent conservative treatment without dialysis and 87% started chronic dialysis treatment, with 11% undergoing peritoneal dialysis. Of the 339 patients who started chronic HD, 12% were referred to other centres due to lack of available beds in our hospital. Consequently, during the study period 297 incident patients were treated with chronic HD; of which 63 (21%) were more than 75 years old and were included in the study. Follow-up ended on 1 December 2010. The mean follow-up time was 27.4±20.7 months. All patients alive at the end of the study were monitored for more than 12 months.</p><p class="elsevierStylePara">Treatment was undergone in a hospital HD unit, following a programme of 3 weekly sessions with a total duration of 10.5–12 hours per week to maintain eKt/V≥1.2. During the study period, we used medium-to-low-flux biocompatible synthetic membranes and low-molecular-weight heparin as anticoagulant. Since 2006, our HD unit has undergone internal and external audits and it is accredited and certified with a quality management system in accordance with ISO standards 9000-2001 and 2008.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study variables</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The following parameters with prognostic significance were gathered from the REIN<span class="elsevierStyleSup">18</span> (Table 1) and RMRC<span class="elsevierStyleSup">19</span> (Table 2) predictive indices for mortality: age, sex, primary renal disease (categorised as standard, diabetic or systemic), degree of functional independence (categorised as normal, limited but able to care for themselves, and unable to provide self-care) body mass index, type of vascular access (catheter, arteriovenous fistula or graft), type of HD onset (planned or unplanned) and co-morbidities (diabetes mellitus, NYHA class III and IV congestive heart failure, ischaemic heart disease, arrhythmias, stage III and IV peripheral vascular disease, active neoplasia, chronic obstructive pulmonary disease, chronic liver disease and severe behaviour disorders). The total number of accompanying diseases was calculated. Systemic primary renal disease was defined as a disease secondary to vasculitis, amyloidosis, myeloma, lupus or haemolytic-uraemic syndrome, and standard primary renal disease was defined as a disease not caused by diabetes or a systemic condition.<span class="elsevierStyleSup">19</span> Severe behaviour disorder was classified according to the definition given by Couchoud et al,<span class="elsevierStyleSup">18</span> that is, one affecting a patient's independence or treatment compliance. It included patients with severe dementia, psychosis or neurosis. Onset of HD was considered unplanned in cases in which the first session was administered under emergency conditions requiring that dialysis be initiated in less than 24 hours.<span class="elsevierStyleSup">18</span> The date of HD onset was recorded, as were dates and causes of death where applicable.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Calculating REIN and RMRC prognostic scores</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">For each patient in the study cohort, we determined real mortality at 6 months and 12 months after starting HD (Table 3), predicted mortality at 6 months according to the REIN registry's prognostic clinical score for elderly patients<span class="elsevierStyleSup">18</span> (Table 4) and probability of death at 12 months following HD onset according to the Catalan registry RMRC’s predictive model.<span class="elsevierStyleSup">19</span> The REIN score was calculated by totalling the points awarded according to each of the model’s risk factors (Table 1).<span class="elsevierStyleSup">18</span> The REIN score does not include age as a mortality factor since the model was created using data from patients in the French registry who were aged 75 years and older, and it therefore only applies to elderly patients. RMRC score was calculated by applying the equation shown in Figure 2.<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara">In this equation, Π (<span class="elsevierStyleItalic">x</span>) is the probability of death during the first 12 months of HD treatment; β<span class="elsevierStyleInf"> </span>is the constant for the logistic regression model (−5.799) and β<span class="elsevierStyleInf">1<span class="elsevierStyleItalic">x</span></span><span class="elsevierStyleItalic"> </span>is the sum of the different â<span class="elsevierStyleInf"> </span>coefficients applicable according to the model’s risk factors present in a specific patient (Table 2).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> </span></p><p class="elsevierStylePara">We compared prognoses observed in our cohort with predictions made using the two study methods in order to determine whether or not the models would be useful in predicting individual prognoses in clinical practice. Statistical analysis was performed using SPSS software for Windows, version 15. We used descriptive statistics with a 95% confidence interval (CI) for means and proportions; Fisher’s exact test and the Mann-Whitney U test as non-parametric tests for comparing qualitative and quantitative variables, respectively; Kaplan-Meier curves to analyse survival data; and ROC (<span class="elsevierStyleItalic">Receiver Operating Characteristic</span>) curves to analyse for concordance with prognostic indices. Values of <span class="elsevierStyleItalic">P</span><.05 were considered statistically significant.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We studied 63 patients with a mean age of 80.4 ± 3.9 years (range: 75.4-91.8); 60% were male. The most frequent cause of primary kidney disease was vascular (37%), followed by diabetic nephropathy (19%). The mean length of the pre-dialysis follow-up was 3.9+4.1 years (range, 0–15.8). Patients who started chronic HD had not undergone prior nephrological monitoring in 19% of all cases.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">REIN score</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The mean score on the REIN index was 2.9±2.3 (range: 0–8) and it was significantly higher in patients who died during the first 6 months (4.0 vs 2.6; <span class="elsevierStyleItalic">P</span>=.046). Table 1 shows the frequency of different REIN index prognostic factors in our study sample. We observed high incidence rates of heart disease and unplanned onset of HD (52.4%). In many cases, this is due to chronic renal failure becoming acute. Table 4 compares predicted mortality with actual observed mortality for each of the REIN scores.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RMRC index</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Table 5 shows the frequency of early mortality risk factors included in the Catalan register RMRC’s predictive model for our study cohort. It should be stated that many patients have poor functional independence (21% of patients were unable to provide self-care) and 59% of the patients needed a catheter as their first vascular access for HD. The mean number of co-morbidities, excluding CKD, was 3.4±1.8 (range: 0–8).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Prognostic factors for mortality</span></p><p class="elsevierStylePara">We used the Fisher’s exact test to examine the distribution of the different factors included in a patient’s REIN and RMRC prognostic scores, according to whether or not early death occurred, and we only observed a statistically significant association between poor functional independence (need for special care) and 6-month mortality (14% vs 46% mortality rates at 6 months, <span class="elsevierStyleItalic">P</span>=.02).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Observed and predicted mortality rates </span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Mortality rates observed in our population were 20.6% at 6 months and 27% at 12 months, respectively (Figure 3). Table 3 shows the causes of death. Analysis of the average for the entire cohort did not reveal significant differences between observed mortality (27%) and the mean mortality at 1 year mortality predicted by the RMRC index (23.5; 95% CI:19.9%–27.1%). However, there were differences between observed mortality at 6 months (20.6%) and mean mortality at 6 months predicted by the REIN index (17.5%; 95% CI: 14.8%–20.1%).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">ROC curves</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">When ROC curves were analysed in order to study how the two predictive models for mortality (REIN and RMRC) might be applicable to individual patients, we found no statistically significant concordance (area under the curve 0.594, <span class="elsevierStyleItalic">P</span>=.255) between the RMRC index for predicting mortality within 12 months following HD onset and observed mortality (Figure 4). Slight concordance was observed (area under the curve 0.678, <span class="elsevierStyleItalic">P</span>=.049) between the REIN index and observed mortality at 6 months (Figure 5).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Upon evaluating the two predictive models of early mortality in incident patients on HD aged 75 and older and their applicability to daily clinical practice, we did not find good concordance between predicted and observed mortality that would enable us to use these models as prognostic tools to aid in deciding whether or not to start KRT on an individual basis. With regard to the probability of death at 12 months estimated using the Catalan registry’s model (RMRC),<span class="elsevierStyleSup">19</span> observed survival rates for the entire study cohort were similar to calculated predicted rates, but when individual prognostic value was analysed using ROC curves, concordance between observed and predicted mortality was very slight. Concordance of the REIN<span class="elsevierStyleSup">18</span> index’s predictions with observed 6-month mortality rates was only slightly significant, making it of little use for clinical practice. We must point out that in our study sample, there were no patients with a REIN score of 9 or more points; and the predicted 6-month survival rate of such patients is only 38%.<span class="elsevierStyleSup">18</span> On the other hand, the main factor in our cohort indicating poor survival prognosis within 6 months following HD onset was very poor functional independence (being unable to provide self-care), and this has already been described by other authors.<span class="elsevierStyleSup">17,21</span></p><p class="elsevierStylePara">A remarkable 52.4% of patients in our cohort started HD on an unplanned basis according to the criteria employed by the French REIN model, meaning that the first session was administered during an emergency in which the patient needed dialysis in less than 24 hours.<span class="elsevierStyleSup">18</span> Other authors prefer to speak of “suboptimal dialysis initiation” and define it as in-hospital dialysis initiation of dialysis through a central venous catheter or on a dialysis modality that was not planned in advance.<span class="elsevierStyleSup">22</span> In any case, our data are not surprising if we consider the fact that some registries, including the Catalan registry, report that approximately 35% of all adult patients and 40% of those older than 75 start chronic HD treatment during an episode of acute or acute on chronic renal failure.<span class="elsevierStyleSup">1</span> On the other hand, the high percentage of unplanned HD initiation in our cohort is similar to that published for Spain<span class="elsevierStyleSup">23</span> and other countries,<span class="elsevierStyleSup">24</span> between 40% and 50%.</p><p class="elsevierStylePara">Another interesting finding is that only 41% of our elderly patients started chronic HD treatment by means of an arteriovenous fistula. The progression of non-proteinuric CKD in the elderly is usually slow, especially if it is due to nephroangiosclerosis.<span class="elsevierStyleSup">24</span> Many elderly patients with stage 4 CKD die before KRT<span class="elsevierStyleSup">25</span> is needed, so creating fistulas for HD is often delayed in such patients until they reach glomerular filtration rates<span class="elsevierStyleSup">26</span> of close to 15ml/min/1.73m<span class="elsevierStyleSup">2</span>. In this context, it is not surprising that many elderly patients with acute on chronic renal failure have no usable fistula for HD initiation.</p><p class="elsevierStylePara">A complex dilemma arises in cases of very elderly CKD patients with numerous co-morbidities as treatment with chronic HD is burdensome, but may produce benefits in terms of survival and quality of life. The matter is open to interpretation and although there are observational studies that show that in patients older than 75 with multiple co-morbidities, especially with ischaemic heart disease, dialysis does not offer better survival rates than conservative treatment without dialysis when considering the survival time from the moment when the glomerular filtration rate<span class="elsevierStyleSup">27</span> falls below 15ml/min/1.73m<span class="elsevierStyleSup">2</span>.</p><p class="elsevierStylePara">The problem arises when we estimate an individual patient prognosis to help decide whether or not to start chronic dialysis. Tools for such a task must be evaluated in the specific contexts (countries, hospitals and concrete clinical practices) in which they will be used. With this in mind, our study shows a poor level of concordance between early mortality observed and early mortality predicted by the two prognostic models in the study, one of which was developed in Spain.</p><p class="elsevierStylePara">This study has certain limitations. Firstly, it is a retrospective study with a relatively small patient sample. On the other hand, we must point out that for very advanced renal failure, our hospital explicitly offers the possibility of conservative palliative treatment without dialysis<span class="elsevierStyleSup">28</span> in addition to KRT techniques, which could introduce a selection bias as patients receiving such treatment were excluded from the study. Likewise, patients were referred to other nearby dialysis centres during the study period due to lack of beds in our hospital, and additionally, the patients we refer to other centres are generally in better clinical condition than those which our department accepts for HD treatment. For these reasons, our early mortality rates would have been lower if we had not referred these patients to other hospitals, thereby losing them to follow-up. Despite these limitations, we believe that an interesting aspect of our study is that it was carried out under the normal conditions of clinical practice in a nephrology department with an active education and information programme for patients with advanced CKD.</p><p class="elsevierStylePara">In conclusion, after having evaluated the usefulness of two new prognostic indices predicting the probability of early mortality in patients older than 75 who started chronic HD in our hospital, we observe that neither the 1-year mortality index developed by the Catalan registry RMRC nor the 6-month mortality index developed by the French registry REIN were useful as prognostic tools in our clinical practice.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p><p class="elsevierStylePara"><a href="grande/11159_16025_27314_en_t1_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27314_en_t1_11159i.jpg" alt="Prognostic index developed by the French registry REIN"></img></a></p><p class="elsevierStylePara">Table 1. Prognostic index developed by the French registry REIN</p><p class="elsevierStylePara"><a href="grande/11159_16025_27316_en_t2_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27316_en_t2_11159i.jpg" alt="Prognostic model for mortality developed by the Catalan Registry RMRC"></img></a></p><p class="elsevierStylePara">Table 2. Prognostic model for mortality developed by the Catalan Registry RMRC</p><p class="elsevierStylePara"><a href="grande/11159_16025_27317_en_t3_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27317_en_t3_11159i.jpg" alt="Early mortality observed in patients older than 74 years in our cohort"></img></a></p><p class="elsevierStylePara">Table 3. Early mortality observed in patients older than 74 years in our cohort</p><p class="elsevierStylePara"><a href="grande/11159_16025_27318_en_t4_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27318_en_t4_11159i.jpg" alt="Mortality during first 6 months on dialysis and REIN index score"></img></a></p><p class="elsevierStylePara">Table 4. Mortality during first 6 months on dialysis and REIN index score</p><p class="elsevierStylePara"><a href="grande/11159_16025_27320_en_t5_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27320_en_t5_11159i.jpg" alt="Frequency of different RMRC index mortality risk factors in our cohort"></img></a></p><p class="elsevierStylePara">Table 5. Frequency of different RMRC index mortality risk factors in our cohort</p><p class="elsevierStylePara"><a href="grande/11159_16025_27321_en_f1_11159i2.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27321_en_f1_11159i2.jpg" alt="Kidney replacement therapy in our patients with stage 5 chronic kidney disease (2004-2009)"></img></a></p><p class="elsevierStylePara">Figure 1. Kidney replacement therapy in our patients with stage 5 chronic kidney disease (2004-2009)</p><p class="elsevierStylePara"><a href="grande/11159_16025_27325_en_f2_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27325_en_f2_11159i.jpg" alt="Formula for calculating the RMRC index"></img></a></p><p class="elsevierStylePara">Figure 2. Formula for calculating the RMRC index</p><p class="elsevierStylePara"><a href="grande/11159_16025_27327_en_f3_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27327_en_f3_11159i.jpg" alt="Survival curve of patients older than 75 years on chronic haemodialysis"></img></a></p><p class="elsevierStylePara">Figure 3. Survival curve of patients older than 75 years on chronic haemodialysis</p><p class="elsevierStylePara"><a href="grande/11159_16025_27329_en_f4_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27329_en_f4_11159i.jpg" alt="ROC curve for the predictive model of early mortality during haemodialysis, developed by the Catalan Registry RMRC"></img></a></p><p class="elsevierStylePara">Figure 4. ROC curve for the predictive model of early mortality during haemodialysis, developed by the Catalan Registry RMRC</p><p class="elsevierStylePara"><a href="grande/11159_16025_27331_en_f5_11159i.jpg" class="elsevierStyleCrossRefs"><img src="11159_16025_27331_en_f5_11159i.jpg" alt="ROC curve for the French registry REIN¿s predictive model of mortality"></img></a></p><p class="elsevierStylePara">Figure 5. ROC curve for the French registry REIN¿s predictive model of mortality</p>" "pdfFichero" => "P1-E534-S3437-A11159-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438773" "palabras" => array:1 [ 0 => "Edad avanzada" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438775" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438777" "palabras" => array:1 [ 0 => "Toma de decisiones" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438779" "palabras" => array:1 [ 0 => "Índices pronósticos" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438781" "palabras" => array:1 [ 0 => "Mortalidad precoz" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438774" "palabras" => array:1 [ 0 => "Elderly" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438776" "palabras" => array:1 [ 0 => "Haemodialysis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438778" "palabras" => array:1 [ 0 => "Decision making" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438780" "palabras" => array:1 [ 0 => "Prognosis score" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438782" "palabras" => array:1 [ 0 => "Early mortality" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción: </span>Existen pocos estudios sobre el pronóstico individual del paciente añoso que inicia hemodiálisis (HD) crónica, pese a que frecuentemente se plantea el dilema entre el posible beneficio y la carga que supone el propio tratamiento. <span class="elsevierStyleBold">Objetivos: </span>Evaluar la utilidad del índice pronóstico del Registro REIN (REIN) y del modelo predictivo de mortalidad precoz del <span class="elsevierStyleItalic">Registre de Malalts Renals de Catalunya</span> (RMRC) en pacientes añosos incidentes en HD al compararlos con la supervivencia observada. <span class="elsevierStyleBold">Métodos:</span> Se estudiaron los pacientes mayores de 75 años que iniciaron y siguieron HD en nuestro Servicio entre 2004-2009. Se recogieron variables sociodemográficas, clínicas, comorbilidad, mortalidad y si el inicio de HD fue planificado o no. Se calculó el índice REIN y la probabilidad de mortalidad precoz del RMRC. <span class="elsevierStyleBold">Resultados:</span> Se analizaron 63 pacientes de una edad media de 80,4 ± 3,9 años, con un número de enfermedades añadidas de 3,4 ± 1,8. Un 59% iniciaron HD por un catéter, un 57,1% tenían enfermedad cardiovascular, el 15,9% neoplasia, el 31,2% enfermedad pulmonar obstructiva crónica y el 19% nefropatía diabética. La supervivencia observada a los 6 y a los 12 meses fue de 79,4 y 73%, respectivamente. Los pacientes que no se valían por sí mismos (21%) presentaban una mayor mortalidad a los 6 meses. El análisis de las curvas ROC (R<span class="elsevierStyleItalic">eceiver Operating Characteristic</span>) mostró una escasa concordancia entre la mortalidad observada y los índices REIN (área 0,681, p = 0,046) y RMRC (área 0,594, p = 0,255). <span class="elsevierStyleBold">Conclusiones:</span> El índice de probabilidad de mortalidad al año del RMRC es poco útil en la práctica clínica para el pronóstico individual. El índice REIN es sólo ligeramente concordante con la mortalidad observada en los primeros 6 meses de HD. Una pobre autonomía funcional fue el principal factor de riesgo de mortalidad precoz en los pacientes añosos que inician HD.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction:</span><span class="elsevierStyleBold"> </span>Few studies address the individual prognosis of an elderly patient beginning chronic haemodialysis (HD), despite the fact that doctors must frequently weigh the possible benefits and disadvantages of prescribing this treatment. <span class="elsevierStyleBold">Objectives: </span>Evaluate the usefulness of the REIN Registry’s prognosis score and the predictive index for early mortality proposed by the Catalan Registry of Renal Patients (RMRC, <span class="elsevierStyleItalic">Registre de Malalts Renals de Catalunya</span>) in elderly patients beginning HD by comparing indices with observed survival rates. <span class="elsevierStyleBold">Methods:</span> We studied patients aged 75 years and older who started and continued HD treatment in our Department between 2004 and 2009. Socio-demographic, clinical, co-morbidity and mortality data were recorded, in addition to whether or not initiating HD was planned. We calculated the REIN score and the RMRC probability of early mortality. <span class="elsevierStyleBold">Results:</span> We analysed 63 patients with a mean age of 80.4±3.9 years and a mean of 3.4±1.8 additional illnesses. Of these patients, 59% began HD with a catheter; 57.1% had cardiovascular disease, 15.9% neoplasia, 31.2% chronic obstructive pulmonary disease and 19% diabetic nephropathy. Survival rates observed at 6 and at 12 months were 79.4% and 73%, respectively. Patients who began HD on an emergency basis (47.7%) or who were unable to care for themselves (21%) had higher 6-month mortality rates. Analysis of ROC curves (Receiver Operating Characteristic) showed slight concordance between the observed mortality rates and both the REIN score (area 0.681, <span class="elsevierStyleItalic">P</span>=.046) and the RMRC index (area 0.594, <span class="elsevierStyleItalic">P</span>=.255). <span class="elsevierStyleBold">Conclusions:</span> The RMRC 1-year mortality probability model is not well adapted for individual prognoses in clinical practice. The REIN score only shows slight concordance with the mortality rates observed in the first 6 months of HD. Poor functional independence was the main risk factor for early mortality in elderly patients beginning HD treatment.</p>" ] ] "multimedia" => array:10 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27314_en_t1_11159i.jpg" "Alto" => 755 "Ancho" => 2176 "Tamanyo" => 479065 ] ] "descripcion" => array:1 [ "en" => "Prognostic index developed by the French registry REIN" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27316_en_t2_11159i.jpg" "Alto" => 1683 "Ancho" => 2179 "Tamanyo" => 790603 ] ] "descripcion" => array:1 [ "en" => "Prognostic model for mortality developed by the Catalan Registry RMRC" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27317_en_t3_11159i.jpg" "Alto" => 745 "Ancho" => 1067 "Tamanyo" => 270233 ] ] "descripcion" => array:1 [ "en" => "Early mortality observed in patients older than 74 years in our cohort" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27318_en_t4_11159i.jpg" "Alto" => 455 "Ancho" => 2163 "Tamanyo" => 299701 ] ] "descripcion" => array:1 [ "en" => "Mortality during first 6 months on dialysis and REIN index score" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Tab. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27320_en_t5_11159i.jpg" "Alto" => 1020 "Ancho" => 1063 "Tamanyo" => 335685 ] ] "descripcion" => array:1 [ "en" => "Frequency of different RMRC index mortality risk factors in our cohort" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27321_en_f1_11159i2.jpg" "Alto" => 925 "Ancho" => 1009 "Tamanyo" => 300650 ] ] "descripcion" => array:1 [ "en" => "Kidney replacement therapy in our patients with stage 5 chronic kidney disease (2004-2009)" ] ] 6 => array:8 [ "identificador" => "fig7" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27325_en_f2_11159i.jpg" "Alto" => 301 "Ancho" => 947 "Tamanyo" => 628504 ] ] "descripcion" => array:1 [ "en" => "Formula for calculating the RMRC index" ] ] 7 => array:8 [ "identificador" => "fig8" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27327_en_f3_11159i.jpg" "Alto" => 958 "Ancho" => 981 "Tamanyo" => 389384 ] ] "descripcion" => array:1 [ "en" => "Survival curve of patients older than 75 years on chronic haemodialysis" ] ] 8 => array:8 [ "identificador" => "fig9" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27329_en_f4_11159i.jpg" "Alto" => 892 "Ancho" => 1004 "Tamanyo" => 257810 ] ] "descripcion" => array:1 [ "en" => "ROC curve for the predictive model of early mortality during haemodialysis, developed by the Catalan Registry RMRC" ] ] 9 => array:8 [ "identificador" => "fig10" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11159_16025_27331_en_f5_11159i.jpg" "Alto" => 883 "Ancho" => 1009 "Tamanyo" => 247401 ] ] "descripcion" => array:1 [ "en" => "ROC curve for the French registry REIN¿s predictive model of mortality" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1.\u{A0}Registre de Malalts Renals de Catalunya. Informe Estadístico 2009. Generalitat de Catalunya. Departamento de Salud. Barcelona, 2011. Available at: http://www20.gencat.cat/docs/canalsalut/Minisite/Trasplantament/Registres activitat/Registre de malalts renals/Arxius/Informe 2009 FINAL.pdf" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "US Renal Data System: USRDS 2010 Annual Data Report. Atlas of End-Stage Renal Disease in the United States. Incidence & Prevalence. Am J Kidney Dis 2011;57(Suppl 1):e253-66." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kurella M, Covinsky MD, Collins AJ, Chertow GM. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 2007;146:177-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17283348" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009;361:1539-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19828531" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Biesen W, Lameire N, Veys N, Vanderhaegen B. From curing to caring: one character change makes a world of difference. Issues related to withholding/withdrawing renal replacement therapy from patients with important co-morbidities. Nephrol Dial Transplant 2004;19:536-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14767005" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Arnold RM, Zeidel ML. Dialysis in frail elders. A role for palliative care. N Engl J Med 2009;361:1597-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19828538" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jassal SV, Watson D. Dialysis in late life: benefit or burden. Clin J Am Soc Nephrol 2009;4:2008-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19965545" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Couchoud C. Can we predict death in patients on dialysis? Nat Rev Nephrol 2010;6:388-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20585316" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Charlson ME, Pompei P, Ales AL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3558716" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Khan I, Catto G, Edward N, Fleming LW, Henderson IS, MacLeod AM.\u{A0}Influence of coexisting disease on survival on renal-replacement therapy. Lancet 1993;341:415-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8094182" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Davies SJ, Rusell L, Bryan J, Phillips L, Russell GI. Comorbidity, urea kinertics and appetite in continous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. Am J Kidney Dis 1995;26:353-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7645541" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Liu J, Huang Z, Gilbertson DT, Foley RN, Collins AJ. An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int 2010;77:141-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19907414" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients.\u{A0}Am J Med 2000;108:609-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10856407" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Angoso M, Alcalde G, Álvarez-Ude F, Arenas MD; (SEN) Sociedad Española de Nefrología. Gestión de Calidad en Hemodiálisis. En: Maduell F (ed.). Guía de Centros de Hemodiálisis. Nefrologia 2006;26 Suppl 8:73-87. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17802671" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Manen JG, Korevaar JC, Dekker FW, Boeschoten EW, Bossuyt PMM, Krediet RT. How to adjust for comorbidity in survival studies in ESRD patients: A comparison of different indices. Am J Kidney Dis 2002;40:82-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12087565" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Manen JG, Van Dijk PCW, Stel VS, Dekker FW, Clèries M, Conte F, et al. Confounding effect of comorbidity in survival studies in patients on renal replacement therapy. Nephrol Dial Transplant 2007;22:187-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16998216" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Górriz JL, Sancho A, Pallardó LM, Amoedo ML, Martín M, Sanz P, et al. Significado pronóstico de la diálisis programada en pacientes que inician tratamiento sustitutivo renal. Un estudio multicéntrico español. Nefrologia 2002;22:49-59. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11987685" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Couchoud C, Labeeuw M, Moranne O, Labeeuw M, Moranne O, Allot V, et al.; French Renal Epidemiology and Information Network (REIN) registry.\u{A0}A clinical score to predict 6-month prognosis starting dialysis for end-stage renal disease. Nephrol Dial Transplant 2009;24:1553-61." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mauri JM, Clèries M, Vela E, Catalan Renal Registry. Design and validation of a model to predict early mortality in haemodialysis patients. Nephrol Dial Transplant 2008;23:1690-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18272779" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cohen LM, Ruthazer R, Moss AH, Germain MJ. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol 2010;5:72-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19965531" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kurella M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009;361:1539-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19828531" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mendelssohn DC, Malmberg C, Hamandi B. An integrated review of "unplanned" dialysis initiation: reframing the terminology to "suboptimal" initiation. BMC Nephrology 2009;10:22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19674452" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Marrón B, Martínez-Ocaña JC, Salgueira M, Barril G, Lamas JM, Martín M, et al; on behalf of the Spanish Group for CKD. Analysis of patient flow into dialysis: role of education in choice of dialysis modality. Perit Dial Int 2005;25 Suppl 3:S56-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16048258" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hemmelgarn BR, Zhang J, Manns BJ, Tonelli M, Larsen E, Ghali WA,\u{A0}et al. Progression of the kidney disfunction in the community-dwelling elderly. Kidney Int 2006;69:2155-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16531986" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Keith D, Nichols GA, Gullion C, Brown JB, Smith DH. Longitudinal follow-up and outcome among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164:659-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15037495" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "O¿Hare AM, Bertenthal D, Walter LC, Garg AX, Covinsky K, Kaufman JS, et al. When to refer patients with chronic kidney disease for vascular access surgery: Should age be a consideration? Kidney Int 2007;71:555-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17245396" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 2007;22:1955-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17412702" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García García M, Martínez Ocaña JC, Rodríguez Jornet A, Almirall J, Ponz E, Ibeas J, et al. Elección de no diálisis en insuficiencia renal crónica en estadio V (fallo renal). Evolución de las características de los pacientes entre 1992-1995 y 2000-2003. Nefrologia 2007;27:574-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18045033" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000002/v0_201502091616/X2013251412000891/v0_201502091617/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000002/v0_201502091616/X2013251412000891/v0_201502091617/en/P1-E534-S3437-A11159-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000891?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 17 | 37 |
| 2024 October | 144 | 60 | 204 |
| 2024 September | 111 | 65 | 176 |
| 2024 August | 111 | 75 | 186 |
| 2024 July | 117 | 41 | 158 |
| 2024 June | 99 | 51 | 150 |
| 2024 May | 100 | 46 | 146 |
| 2024 April | 103 | 47 | 150 |
| 2024 March | 65 | 30 | 95 |
| 2024 February | 79 | 39 | 118 |
| 2024 January | 90 | 33 | 123 |
| 2023 December | 73 | 31 | 104 |
| 2023 November | 84 | 37 | 121 |
| 2023 October | 68 | 43 | 111 |
| 2023 September | 78 | 42 | 120 |
| 2023 August | 65 | 19 | 84 |
| 2023 July | 110 | 32 | 142 |
| 2023 June | 106 | 33 | 139 |
| 2023 May | 70 | 39 | 109 |
| 2023 April | 62 | 42 | 104 |
| 2023 March | 68 | 31 | 99 |
| 2023 February | 64 | 14 | 78 |
| 2023 January | 76 | 39 | 115 |
| 2022 December | 106 | 47 | 153 |
| 2022 November | 72 | 40 | 112 |
| 2022 October | 70 | 44 | 114 |
| 2022 September | 66 | 33 | 99 |
| 2022 August | 56 | 50 | 106 |
| 2022 July | 59 | 99 | 158 |
| 2022 June | 48 | 38 | 86 |
| 2022 May | 48 | 58 | 106 |
| 2022 April | 68 | 52 | 120 |
| 2022 March | 50 | 67 | 117 |
| 2022 February | 60 | 47 | 107 |
| 2022 January | 78 | 48 | 126 |
| 2021 December | 60 | 44 | 104 |
| 2021 November | 68 | 54 | 122 |
| 2021 October | 62 | 60 | 122 |
| 2021 September | 70 | 45 | 115 |
| 2021 August | 69 | 41 | 110 |
| 2021 July | 79 | 49 | 128 |
| 2021 June | 61 | 21 | 82 |
| 2021 May | 118 | 41 | 159 |
| 2021 April | 168 | 79 | 247 |
| 2021 March | 135 | 46 | 181 |
| 2021 February | 85 | 32 | 117 |
| 2021 January | 60 | 21 | 81 |
| 2020 December | 47 | 18 | 65 |
| 2020 November | 68 | 13 | 81 |
| 2020 October | 48 | 17 | 65 |
| 2020 September | 46 | 14 | 60 |
| 2020 August | 52 | 18 | 70 |
| 2020 July | 46 | 11 | 57 |
| 2020 June | 48 | 11 | 59 |
| 2020 May | 57 | 14 | 71 |
| 2020 April | 44 | 20 | 64 |
| 2020 March | 45 | 14 | 59 |
| 2020 February | 48 | 20 | 68 |
| 2020 January | 64 | 22 | 86 |
| 2019 December | 79 | 21 | 100 |
| 2019 November | 61 | 26 | 87 |
| 2019 October | 55 | 15 | 70 |
| 2019 September | 83 | 32 | 115 |
| 2019 August | 56 | 18 | 74 |
| 2019 July | 69 | 29 | 98 |
| 2019 June | 72 | 16 | 88 |
| 2019 May | 64 | 20 | 84 |
| 2019 April | 110 | 39 | 149 |
| 2019 March | 64 | 30 | 94 |
| 2019 February | 50 | 25 | 75 |
| 2019 January | 74 | 21 | 95 |
| 2018 December | 148 | 40 | 188 |
| 2018 November | 111 | 20 | 131 |
| 2018 October | 127 | 13 | 140 |
| 2018 September | 138 | 18 | 156 |
| 2018 August | 121 | 19 | 140 |
| 2018 July | 92 | 13 | 105 |
| 2018 June | 93 | 16 | 109 |
| 2018 May | 99 | 23 | 122 |
| 2018 April | 114 | 12 | 126 |
| 2018 March | 100 | 17 | 117 |
| 2018 February | 79 | 8 | 87 |
| 2018 January | 88 | 7 | 95 |
| 2017 December | 102 | 13 | 115 |
| 2017 November | 92 | 7 | 99 |
| 2017 October | 96 | 13 | 109 |
| 2017 September | 79 | 11 | 90 |
| 2017 August | 63 | 8 | 71 |
| 2017 July | 99 | 15 | 114 |
| 2017 June | 110 | 5 | 115 |
| 2017 May | 110 | 16 | 126 |
| 2017 April | 100 | 6 | 106 |
| 2017 March | 91 | 23 | 114 |
| 2017 February | 95 | 18 | 113 |
| 2017 January | 107 | 12 | 119 |
| 2016 December | 114 | 8 | 122 |
| 2016 November | 158 | 17 | 175 |
| 2016 October | 200 | 11 | 211 |
| 2016 September | 332 | 11 | 343 |
| 2016 August | 364 | 11 | 375 |
| 2016 July | 302 | 25 | 327 |
| 2016 June | 186 | 0 | 186 |
| 2016 May | 176 | 0 | 176 |
| 2016 April | 156 | 0 | 156 |
| 2016 March | 151 | 0 | 151 |
| 2016 February | 159 | 0 | 159 |
| 2016 January | 161 | 0 | 161 |
| 2015 December | 154 | 0 | 154 |
| 2015 November | 139 | 0 | 139 |
| 2015 October | 121 | 0 | 121 |
| 2015 September | 113 | 0 | 113 |
| 2015 August | 96 | 0 | 96 |
| 2015 July | 93 | 0 | 93 |
| 2015 June | 47 | 0 | 47 |
| 2015 May | 56 | 0 | 56 |
| 2015 April | 6 | 0 | 6 |
Show all
