1. The Surprise Question (SQ): "Would you be surprised if this patient died in the next 12 months?" |
A simple and useful tool to identify patients at greater risk of death. Applicable at any stage of CKD.6060 Javier AD, Figueroa R, Siew ED, Salat H, Morse J, Stewart TG, et al. Reliability and utility of the surprise question in CKD stages 4 to 5. Am J Kidney Dis. 2017 Jul;70(1):93-101.
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2. AKPS (Australia-modified Karnofsky Performance Status scale) or KPS (Karnofsky Performance Scale) |
Tools used to assess the patient's functional status. A patient with AKPS or KPS of less than 50% is eligible for palliative care. That is, a patient who, due to one or more chronic diseases, spends at least 50% of the time sitting or lying down, without considering sleep time.6161 Abernethy AP, Shelby-James T, Fazekas BS, Woods D, Currow DC. The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice. BMC Palliat Care. 2005;4:7.
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3. Modified Charlson score (MCS) |
A tool that adds comorbidities scores (9 in total) to age scores (an additional point for each decade above the age of 40) to identify patients on dialysis with a higher risk of death.6262 Hemmelgarn BR, Manns BJ, Quan H, Ghali WA. Adapting the Charlson comorbidity index for use in patients with ESRD. Am J Kidney Dis. 2003 Jul;42(1):125-32.
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4. Fried Phenotype Model |
Frailty is highly prevalent in CKD and associated with increased risk of hospitalization and mortality.6363 Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: a systematic review. Arch Gerontol Geriatr. 2017 Jan/Feb;68:135-42.
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5. Bansal Score |
This tool uses nine clinical variables (age, sex, race, eGFR, albumin / creatinine ratio, diabetes, smoking, heart failure and stroke) to estimate the risk of death at 5 years in the elderly (≥ 70 years) with non-dialytic DRC (stages 3 and 4).6464 Bansal N, Katz R, Boer IH, Peralta CA, Fried LF, Siscovick DS, et al. Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. Clin J Am Soc Nephrol. 2015 Mar;10(3):363-71.
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6. REIN Score |
REIN Score Instrument validated to stratify the risk of death in 3 months of elderly patients (> 75 years) who intend to initiate dialysis6565 Couchoud CG, Beuscart JB, Aldigier JC, Brunet PJ, Moranne OP, REIN registry. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int. 2015 Nov;88(5):1178-86.
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7. Cohen 6-month Mortality Predictor (available at: http://touchcalc.com/calculators/sq) |
An instrument that combines SQ with four variables - age, serum albumin, presence of dementia and peripheral vascular disease - to predict the risk of death at 6, 12, or 18 months for hemodialysis patients.6666 Cohen LM, Ruthazer R, Moss AH, Germain MJ. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol. 2010 Jan;5(1):72-9.
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8. KDIGO Clinical Outcomes in CKD (available at: https://kdigo.org/equation/) |
This tool estimates concomitantly the risks of death, RRT, and any cardiovascular disease in 2 and 4 years in patients with CKD with eGFR between 15 and 30 mL/min/1.73m2 and aged between 30 and 85 years. |