External validation and clinical utility of a prediction model for 6-month mortality in patients undergoing hemodialysis for end-stage kidney disease:

Background:End-stage kidney disease is associated with poor prognosis. Health care professionals must be prepared to address end-of-life issues and identify those at high risk for dying. A 6-month mortality prediction model for patients on dialysis derived in the United States is used but has not been externally validated.Aim:We aimed to assess the external validity and clinical utility in an independent cohort in Canada.Design:We examined the performance of the published 6-month mortality prediction model, using discrimination, calibration, and decision curve analyses.Setting/participants:Data were derived from a cohort of 374 prevalent dialysis patients in two regions of British Columbia, Canada, which included serum albumin, age, peripheral vascular disease, dementia, and answers to the “the surprise question” (“Would I be surprised if this patient died within the next year?”).Results:The observed mortality in the validation cohort was 11.5% at 6 months. The prediction model had reasonable discriminati...