ArticlePloS one2021
Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Comprehensive Conservative Management as Rescue Therapy After Haemodialysis Failure: Two Case Reports.Clinics and practice · 2026Article
- Predicting mortality in elderly chronic kidney disease patients using algorithmic risk assessment: a Southeast Asian perspective.BMC nephrology · 2025Article
- Chronic kidney disease-related sarcopenia as a prognostic indicator in elderly haemodialysis patients.BMC nephrology · 2023Observational
- Article
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11 authors.
Funding
Abstract
RATIONAL AND
objectivePrognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. STUDY
designValidation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance ("c")-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. SETTING &
participantsIncident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. ESTABLISHED PREDICTORS: Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality.
resultsIn our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. LIMITATIONS: Small sample size, use of secondary data, need for imputation, homogeneous population.
conclusionMost predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.
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