Survival analysis for older and frail patients starting dialysis and external validation of the REIN scale

Aim: many old and frail patients with CKD reveal significant comorbidity, although progress to the stage 5 for a more prolonged period. This ambiguity makes the decisions concerning dialysis start in these patients rather subjective. By the time of dialysis start, decision-taking the worsening of patient`s somatic and mental condition can arise the question about reasonableness of renal replacement therapy considering nearest prognosis. The scale system REIN has been proposed for short-term prognosis for older patients starting dialysis. Methods: we performed the external validation of the REIN scale in unselected Russian population from city renal replacement therapy register. Results: up to score 11 actual mortality coincided with predicted by REIN. We found rapid growth of mortality with further elevation of the scale up to score 18 where the mortality was 100%. The survival in groups with scale below 12, with 12-16 and >16 dramatically diverged, but predicted risks for score 6 and 11 were higher than actual mortality in our group with scores up to 11, while for others the survival was significantly lower than predicted. C-statistic in ROC analysis was 0.793 (95%CI 0.692-0.894). Three-month mortality in low-risk group (score <12) was 4.4%, in medium risk group (12-16) it was 42.9%, in high risk group (>16) it was 100%. Conclusion: REIN scale is a useful tool for the perspective of treatment evaluation in older and frail patients; it can help in decision-making while starting dialysis or refusal of renal replacement therapy in favor of comprehensive conservative treatment. Perhaps, additional factors should be included in model to improve its prognostic value.

старт диализа, коморбидность, астения, выживаемость, dialysis start, comorbidity, frailty, survival

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