Development and Validation of a Transfusion Risk Score for Patients Receiving Maintenance Hemodialysis. Issue 6 (24th June 2021)

• Record Type: Journal Article
• Authors: Gilbertson, David T.; Yan, Heng; Xu, Hairong; Sinsakul, Marvin; Peng, Yi; Wetmore, James B.; Liu, Jiannong; Li, Suying
• Is Part Of: Kidney360. Volume 2:Issue 6(2021)
• Page Start: 948
• Page End: 954
• Publication Date: 2021-06-24
• Subjects: dialysis -- blood transfusion -- hemodialysis -- maintenance -- risk factors; 616.61
• DOI: 10.34067/KID.0004512020
• Languages: English
• ISSNs: 2641-7650

Abstract

Visual Abstract: Abstract: Key Points: Variables most predictive of transfusion were previous transfusion, hemoglobin, ferritin, and length of hospitalization at baseline. Our transfusion prediction risk score performed well. It could be further developed into a clinically useful tool. The score could allow clinicians to identify hemodialysis patients most likely to benefit from an anemia treatment to avoid transfusions. Background: In patients on dialysis with anemia, avoiding red blood cell transfusions is preferable. We sought to develop and validate a novel transfusion prediction risk score for patients receiving maintenance hemodialysis. Methods: This retrospective cohort study used United States Renal Data System data to create a model development cohort (patients who were point prevalent and on hemodialysis on November 1, 2012) and a validation cohort (patients who were point prevalent and on hemodialysis on August 1, 2013). We characterized comorbidity, inflammatory conditions, hospitalizations, anemia and anemia management, iron parameters, intravenous iron use, and vitamin D use during a 6-month baseline period to predict subsequent 3-month transfusion risk. We used logistic least absolute shrinkage and selection operator regression. In an exploratory analysis, model results were used to calculate a score to predict 6- and 12-month hospitalization and mortality. Results: Variables most predictive of transfusion were prior transfusion, hemoglobin, ferritin, and number of hospital days in the baseline period. The resulting c-statistic in the validation cohort was 0.74, indicating relatively good predictive power. The score was associated with a significantly increased risk of subsequent mortality (hazard ratios 1.0, 1.22, 1.26, 1.54, 1.71, grouped from lowest to highest score), but not with hospitalization. Conclusions: We developed a transfusion prediction risk score with good performance characteristics that was associated with mortality. This score could be further developed into a clinically useful application, allowing clinicians to identify patients on hemodialysis most likely to benefit from a timely, proactive anemia treatment approach, with the goal of avoiding red blood cell transfusions and attendant risks of adverse clinical outcomes.