Predicting Survival in Adults with End-Stage Renal Disease: An Age Equivalence Index

Abstract

To quantify prognosis in patients with end-stage renal disease, we evaluated pretreatment clinical state and ascertained the outcome of all 220 patients who began therapy at two hospitals from 1970 to 1975. Each of three pretreatment characteristics made a statistically significant independent contribution to the relative risk of death: age (relative risk for 10-year increments = 2.2, p less than 0.001); duration of diabetes (relative risk for 10-year increments = 2.2, p less than 0.001); and left-sided heart failure (relative risk = 2.0, p less than 0.001). We combined the effects of these factors in an age-equivalence index that showed a strong gradient in survival rates from lower to higher values; the 5-year survival rate differed between 92% in patients with a score of 30 or less and 6% in patients with a score over 70. This index, which is simple to use, should prove helpful in patient care and can improve the scientific validity of therapeutic comparisons in patients with end-stage renal disease by identifying and adjusting for the selection biases that occur in the allocation of different treatments.

Adjustment for Comorbidity in Studies on Health Status in ESRD Patients

“…In the development and evaluation of comorbidity indices, emphasis has always been on finding a comorbidity index that can adequately stratify patients according to their risk of death. Studies in ESRD patients showed that several types of indices were all predictive of survival (3,(15)(16)(17)(18)(19)(20)(21)(22). In studies in other populations than ESRD patients and with survival as the outcome of interest, it was shown that comorbidity indices provide only a modest improvement on age adjustment and that the performance of different indices is rather similar (23)(24)(25)(26).…”

Mortality in Elderly Patients After Cervical Spine Fractures

“…This index has been validated extensively as a predictor of mortality, for example, in patients with end-stage renal disease and coronary bypass surgery [17][18][19][20] . It has also been utilized to stratify functional outcomes after total joint replacement in a study comparing volume and outcomes 21,22 .…”

Ventricular Arrhythmias and Sudden Cardiac Death in End-Stage Renal Disease Patients on Chronic Hemodialysis

“…Given the natural history of LVH and coronary artery disease (CAD), it is fair to assume that the risk for ventricular arrhythmias begins between the onset of renal disease and the initiation of dialysis and is somehow worsened by HD procedures [19]. In patients with essential hypertension, LVH is a predictor of cardiac death, independent of the blood pressure (BP) [20]. It is, therefore, of interest that LVH is also a predictor of cardiac death in ESRD patients [21].…”