This review summarizes prognostic tools for end-stage kidney disease, highlighting their application in mortality risk assessment, shared decision-making, conservative kidney management, and individualized treatment planning for older adults.
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Review Article
This review summarizes prognostic tools for end-stage kidney disease, highlighting their application in mortality risk assessment, shared decision-making, conservative kidney management, and individualized treatment planning for older adults.
Prognostication in end-stage kidney disease is fundamental to person-centered care and shared decision-making. This review summarizes the current evidence on prognostic assessment in older adults with end-stage kidney disease who are considering dialysis or conservative kidney care. It examines the rationale for prognostication and reviews the principal clinical, functional, and laboratory predictors of mortality, including comorbidity burden, frailty, functional status, and biochemical parameters. The review discusses validated prognostic tools, including the Charlson Comorbidity Index, the Surprise Question, and multivariable prediction models, as well as emerging machine learning approaches for individualized risk prediction. It also examines the effects of functional decline, hospitalization, and limited survival benefit on treatment decisions and highlights the role of prognostic information in advance care planning and goal-concordant care. In addition, the review discusses the communication of prognosis and the practical challenges associated with implementing prognostic tools in routine nephrology practice. By integrating evidence-based prognostic assessment with individualized clinical evaluation and patient values, prognostication can support informed treatment decisions and facilitate personalized care for older adults with end-stage kidney disease.
Chronic kidney disease (CKD) affects an estimated 843.6 million people worldwide, with more than 2 million people living with end-stage kidney disease (ESKD)1,2,3,4,5. Older adults are at increased risk of developing advanced kidney disease, particularly those with cardiovascular disease and other comorbid conditions. Despite major advances in medical therapies, ESKD continues to confer substantial risks of mortality and morbidity1,4.
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The Importance of Prognostication in Chronic Kidney Disease
An understanding of prognosis and the expected course of disease progression can substantially influence therapeutic goals and life decisions. This understanding is essential for delivering person-centered care, fostering shared decision-making, and facilitating advance care planning. However, studies involving people with cancer and older adults have shown that healthcare professionals rarely communicate prognostic information, whereas patients often maintain overly optimistic expectations about the future8.
Progno....
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Prognostication is an important component of shared decision-making. Nephrologists should provide prognostic information accurately and in a person-centered manner to help align proposed treatments with patients’ values and preferences. Prognostic tools, including risk prediction models, can assist nephrologists in providing more nuanced risk assessments. These tools may facilitate the early identification of individuals who could benefit from comprehensive geriatric assessment, advance care planning, or, in select.......
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The authors declare no competing financial interests or conflicts of interest. Also, the authors used an OpenAI image-generation tool to create the initial version of Figure 1. The figure was subsequently reviewed, revised, and approved by the authors, who take full responsibility for its scientific content and clinical accuracy.
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