#459 Clinical tools to stratify conservative kidney management patients with different care needs
Bibliographic record
Abstract
Abstract Background and Aims Personalized care in conservative kidney management (CKM) provides a person-centered care for patient who have opted for non-dialytic therapy. However, the illness trajectory of patients with chronic kidney disease G5 (CKD G5) on CKM can be unpredictable. Previous study suggested a sharp increase in symptom distress and health-related concerns in the 2 months before death. The objectives of this study were to identify clinical tools associated with mortality in patients on CKM, and to evaluate the concordance between preferred and actual place of death. Method This was a single-centre cohort study included 109 CKD G5 patients opted for CKM from April 2021 to September 2024. Baseline demographic, clinical, laboratory data, Clinical Frailty Score (CFS), Edmonton Symptom Assessment System Revised: Renal (ESAS-r: Renal), Resources Utilization Group–Activities of Daily Living scale (RUG-ADLs), Palliative Performance Score (PPS), and Karnofsky Performance Score (KPS) were collected. Logistic regression and survival analysis were performed. Results A total of 109 patients with CKD G5 opted for CKM included in this study with mean (±SD) age of the patients of 79.8 ± 7.3 years, 64.2% were female and 82.6% were Chinese. Primary cause of CKD G5 was diabetes mellitus (69.7%). Baseline mean estimated glomerular filtration rate CKD-EPI (eGFRCKD-EPI) was 10.3 ml/min with Charlson comorbidity index of 8.5, CFS of 4.6 and KPS of 67.3. Median total ESASr-Renal was 1, RUG-ADL was 4, PPS was 60, serum albumin was 38 g/L and haemoglobin was 9.6 g/dL. Sixty-two patients (56.9%) deceased during follow-up with a median survival of 11.9 months. After adjusting for the variables, baseline eGFR CKD-EPI remained the only significant predictor of mortality (Fig. 1). Patients with eGFRCKD-EPI ≤5 ml/min had a median survival of 4 months. PPS score of <50 showed a clear correlation with poorer survival estimate (Fig. 2). The advance care planning completion rate in this cohort was 60.5%. There was a moderate concordance between preferred and actual place of death, with 35.5% of the deceased patients passed away at home. Conclusion Baseline eGFRCKD-EPI is a significant predictor of mortality in CKM patients. PPS demonstrated utility in estimating survival and may aid in timely transition to hospice care. While home remains the preferred place for end-of-life care for most, fulfilling this preference remains challenging. This study highlighted the importance of early identification of patients at-risk and the need for personalized care plans in CKM. Recognition of these poor prognostic value may facilitate timely referral to hospice service.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".