Surviving the year: Predictors of mortality in conservative kidney management.
10.47102/annals-acadmedsg.2025168
- Author:
Swee Ping TEH
1
;
Boon Cheok LAI
1
;
Ivan Wei Zhen LEE
1
;
Shashidhar BAIKUNJE
1
;
Sye Nee TAN
1
;
Lee Ying YEOH
1
Author Information
1. Department of Renal Medicine, Sengkang General Hospital, Singapore.
- Publication Type:Journal Article
- Keywords:
clinical tool;
conservative kidney management;
mortality;
nephrology;
prognosis
- MeSH:
Humans;
Female;
Male;
Aged;
Prospective Studies;
Glomerular Filtration Rate;
Palliative Care/methods*;
Conservative Treatment/methods*;
Aged, 80 and over;
Prognosis;
Serum Albumin/analysis*;
Proportional Hazards Models;
Activities of Daily Living;
Singapore/epidemiology*
- From:Annals of the Academy of Medicine, Singapore
2025;54(9):524-530
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Conservative kidney management (CKM) is a recognised treatment option for selected patients with chronic kidney disease stage 5 (CKD G5), but prognostic indicators for mortality and optimal timing for palliative care transition remain uncertain.
METHOD:This is a single-centre, prospective cohort study of CKD G5 patients who opted for CKM, conducted between April 2021 and September 2024, with longitudinal monitoring of Edmonton Symptom Assessment System Revised: Renal; Palliative Perfor-mance Scale (PPS); Resources Utilisation Group.Activities of Daily Living (RUG-ADL) scale; Clinical Frailty Score; Karnofsky Performance Score; and clinical and laboratory data. Primary outcomes included identifying baseline mortality predictors and validating the PPS for survival estimation. Cox proportional hazards models were used to identify independent predictors of mortality.
RESULTS:Among 109 patients (mean age 79.8±7.3 years, 64.2% female), 62 (56.9%) died during follow-up. Multivariate analysis identified baseline estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08.1.68, P<0.01) and serum albumin (HR 1.24, 95% CI 1.08.1.43, P<0.01) as predictors of 1-year mortality. Median survival varied by eGFR: 3.0 months (95% CI 0.6.2) for eGFR .5 mL/min/1.73 m2, 13.0 months (95% CI 9.1.16.9) for eGFR 6.10 mL/ min/1.73 m2, and 20.0 months (95% CI 16.5.23.5) for eGFR >10 mL/min/1.73 m2 (P<0.01). Subsequent PPS correlated strongly with survival, with median survival of 1.8 months for PPS <50, 5.3 months for PPS 50.60, and 7.9 months for PPS 70.80 (P=0.03).
CONCLUSION:Baseline eGFR and serum albumin predict 1-year mortality in CKM patients. PPS offers a practical tool for identifying patients requiring palliative care transition, supporting personalised care pathways and timely integration of palliative care.
