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

基本信息

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
项目类别：
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

项目摘要

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）：创建老年 ESRD 患者早期死亡率的风险评分算法背景。 65 岁及以上患者的早期死亡率（即诊断终末期肾病 (ESRD) 后三个月内发生的死亡率）过高。慢性肾病 (CKD) 和 ESRD 患者发病率的不断增加促使我们努力减缓和扭转这一紧迫的公共卫生问题。本研究旨在开发一种风险评分系统，以帮助临床预测老年（> 65 岁）ESRD 患者的早期死亡。客观的。我们假设，透析开始后不久“早期死亡率”较高的患者有明显的透析前医疗状况，加上肾脏疾病管理不充分，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确定与前三个死亡率相关的因素开始永久性透析后几个月。我们建议检查与早期死亡相关的以下内容：1）透析前一年内发现的合并症（例如心血管事件、急性肾功能衰竭、脓毒症、高血压急症）； 2) 透析前的医疗管理，包括肾病专家的参与、贫血管理、营养状况和透析血管通路准备，以区分“紧急与选择性”（即急性发作“崩溃和烧伤”与计划）过渡到终末期肾病； 3) CKD 后期使用卫生服务。这些分析的结果将用于开发透析患者早期死亡率的预后模型和评分算法。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，以开发用户友好的预后指数。为了确定研究人群，我们将通过链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素。拟议的研究的独特之处在于将 2000-2009 年 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。这一时期符合医疗保险条件的 CKD 患者总数约为 831,000 人；其中，大约 10% 符合 ESRD 资格，并构成我们研究人群的基础。将使用多元逻辑回归模型来检验每个假设并确定早期死亡的重要风险因素。意义。我们计划在从 CKD 转变为 ESRD 的人群中找出与早期死亡相关的潜在“可改变”因素，这些因素需要昂贵的、永久性的和改变生活的透析治疗。鉴于透析后第一年的高死亡率，准确预测那些注定要过早死亡的人将有助于患者及其家人、医疗服务提供者和社会做出治疗决策。