Creation of a Risk-scoring Algorithm for Early Mortality Among Elderly ESRD Patie

创建老年 ESRD 患者早期死亡率的风险评分算法

• 批准号: 8557705
• 负责人: Mae Thamer
• 金额: $ 16.93万
• 依托单位: MEDICAL TECHNOLOGY AND PRACTICE PATTERNS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-15 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8557705
• 关键词: Acute; Acute Kidney Failure; Affect; Algorithms; Anemia; Awareness; Biological; Blood Vessels; Burn injury; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic Kidney Failure; Classification; Clinical; Clinical Practice Guideline; Clinical Trials; Cohort Studies; Complex; Data; Data Files; Databases; Decision Making; Development; Diabetes Mellitus; Diagnosis; Dialysis patients; Dialysis procedure; Digestive System Disorders; Disease Management; Disease Outcome; District of Columbia; Elderly; Emergency Situation; End stage renal failure; Evaluation; Event; Family; Family health status; Foundations; Future; Government; Grant; Guidelines; Health; Health Services; Healthy People 2010; Incidence; Information Systems; Institutes; Joints; Kidney; Kidney Diseases; Kidney Failure; Laboratories; Life; Link; Logistic Regressions; Medical; Medicare; Medicare claim; Methods; Modeling; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Nutritional status; Outcome; Participant; Patient Care; Patients; Phase; Population; Population Study; Preparation; Prevention; Primary Health Care; Printing; Provider; Public Health; Recording of previous events; Renal Replacement Therapy; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; Sepsis; Societies; Specialist; Staging; Stratification; System; Testing; United States; United States Dept. of Health and Human Services; Update; Validation; base; disability; disease diagnosis; experience; high risk; improved; indexing; mortality; nephrogenesis; older patient; outcome forecast; predictive modeling; prognostic; programs; psychosocial; public health relevance; tool; urologic; user-friendly

DESCRIPTION (provided by applicant): Creation of a Risk-scoring Algorithm for Early Mortality Among Elderly ESRD Patients Background. The rate of early deaths, those occurring within the three months following the diagnosis of end-stage renal disease (ESRD), are disproportionately high among patients who are 65 and older. Inexorable increases in the incidence of patients with both chronic kidney disease (CKD) and ESRD impel efforts to slow and reverse this urgent public health problem. This study aims to develop a risk-scoring system to aid in the clinical prediction of early death among elderly (>65 years) ESRD patients. Objective. We hypothesize that patients with high rates of "early mortality" soon after dialysis initiation have significant pre-dialysis medical conditions combined with inadequate renal disease management that does not prepare them appropriately for long- term dialysis. Our exploratory research project will identify factors associated with mortality within the first three months after starting permanent dialysis. We propose to examine the following associated with early mortality: 1) comorbid conditions found within one year prior to dialysis (e.g., cardiovascular events, acute renal failure, sepsis, hypertensive emergencies); 2) medical management prior to dialysis including involvement of a nephrology specialist, management of anemia, nutritional status, and vascular access preparation for dialysis that differentiates the 'emergent versus elective' (i.e., acute onset 'crash and burn' versus planned) transition to ESRD; and 3) use of health services in the latter stages of CKD. Results from these analyses will be used to develop a prognostic model and scoring algorithm for early mortality among dialysis patients. Methods. Using historical Medicare claims data, we propose to conduct a retrospective cohort study to develop a user friendly prognostic index. To identify the study population, we will construct a complete renal failure patient history by linking the pre-dialysis and post dialysis data to assess the predictors of early death. The proposed study is unique in linking the 2000-2009 ESRD data files to the 5% Chronic Kidney Disease (CKD) sample that has recently become available for research purposes. The total number of Medicare-eligible CKD patients from this period is approximately 831,000; of these, roughly 10% become ESRD-eligible and form the basis of our study population. Multivariate logistic regression models will b used to test each hypothesis and identify the significant risk factors for early mortality. Significance. We plan to identify potentially "modifiable" factors that are associated with early death among a population that transitions from CKD to ESRD requiring expensive, permanent and life-altering dialysis therapy. Given the high mortality rates during the first year after dialsis, accurate prediction of those destined for early death would be useful to patients and their families, providers, and society in making decisions about treatment.

描述（由申请人提供）：在老年ESRD患者背景中创建一种为早期死亡率的风险评分算法。在65岁及65岁及65岁以上的患者中，诊断出终末期肾脏疾病（ESRD）后三个月内发生的早期死亡率不成比例。慢性肾脏疾病（CKD）和ESRD患者的发病率不可阻碍地增加，并推动了缓慢和扭转这一紧急公共卫生问题的努力。这项研究旨在开发一种风险评分系统，以帮助老年人（> 65岁）ESRD患者对早期死亡的临床预测。客观的。我们假设透析起步后不久，“早期死亡率”率高的患者患有明显的透析前医疗状况，以及肾脏疾病管理不足，无法为长期透析做好适当的准备。我们的探索性研究项目将在前三个中确定与死亡率相关的因素 开始永久透析后的几个月。我们建议检查与早期死亡率相关的以下内容：1）在透析前一年内发现的合并症（例如心血管事件，急性肾衰竭，败血症，高血压紧急情况）； 2）透析之前的医疗管理包括肾脏学专家的参与，贫血管理，营养状况和血管通道准备透析的准备，以区分“新兴与选举”（即急性发作和燃烧'vers burn versus versus versus versus versed）过渡到ESRD； 3）在CKD的后期使用健康服务。这些分析的结果将用于开发预后模型和透析患者早期死亡率的评分算法。方法。使用历史医疗保险索赔数据，我们建议进行回顾性队列研究，以开发一个用户友好的预后指数。为了确定研究人群，我们将通过连接透析前和透析后数据来构建完整的肾衰竭患者病史，以评估早期死亡的预测因子。拟议的研究在将2000-2009 ESRD数据文件与最近可用于研究目的的5％慢性肾脏病（CKD）样本联系起来方面是独一无二的。此期间，符合医疗保险资格的CKD患者的总数约为831,000；其中，大约有10％的人符合ESRD资格，并构成了我们研究人群的基础。多元逻辑回归模型将用于检验每个假设并确定早期死亡率的重要风险因素。意义。我们计划确定从CKD到ESRD过渡到需要昂贵，永久且改变生命的透析治疗的人群中与早期死亡有关的潜在“可修改”因素。鉴于拨号后第一年的死亡率很高，因此准确预测原定为早期死亡的人对患者及其家人，提供者和社会在做出有关治疗的决策方面有用。