A Clinically Practical Five-Variable Model to Predict Mortality Risk in Patients with Pre-Dialysis CKD

 

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A Clinically Practical Five-Variable Model to Predict Mortality Risk in Patients with Pre-Dialysis CKD

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Jin
Hu
Jin Hu 798034574@qq.com Soochow University School of Nursing Suzhou China *
Xuefei Wang 3316224602@qq.com Jiangsu Provincial Official Hospital Department of Geriatrics Nanjing China -
Ke Tian 3114815524@qq.com Nanjing Medical University School of Nursing Nanjing China -
Yongzhen Mo moyongzh@sina.com Jiangsu Provincial Official Hospital Office of the Center for Geriatric Health Service Guidance Nanjing China -
 
 
 
 
 
 
 
 
 
 
 

Patients with pre-dialysis CKD face a high risk of mortality and reduced quality of life. Risk prediction models are increasingly recognized as tools to help patients understand their treatment options and support personalized care. However, existing prognostic models for pre-dialysis patients remain underutilized. Developing a simple model based on a small set of readily available predictors could enhance its practical applicability in clinical settings.

Data from 3,545 pre-dialysis patients(defined as those with an eGFR <15 mL/min/1.73 m² not yet on dialysis) were extracted from the MIMIC-IV database. The collected data includes demographic information, vital signs, laboratory indicators, comorbidities, survival status, and survival duration. Variables with a missing rate exceeding 30% were excluded, while those with a missing rate below 30% underwent multiple imputation. Of these patients, 1064 served as the validation group and 2081 served as the training cohort. LASSO regression was used for variable selection, and a Cox regression model was established. The SHapley Additive exPlanations (SHAP) method was then applied to identify the five most important predictors. Based on these predictors, a nomogram was constructed to estimate overall survival (OS). Model performance was assessed via calibration curves, decision curve analysis, time-dependent AUCs, and the concordance index (C-index).

The average age of the patients was 63.0 (52.0, 74.0) years, with a higher proportion of male patients (60.8%). All-cause mortality rates were 12.55%, 17.49%, and 21.47% at 1, 2, and 3 years, respectively.No significant differences were observed between the training and validation groups in clinical baseline characteristics, except for blood phosphorus levels (P < 0.05).

LASSO regression was used to perform variable selection on 23 clinical features in the training set. When  was set to .1se, the model exhibited optimal fit. A total of 11 potential prognostic-related variables were preliminarily selected: gender, age, Charlson comorbidity index, potassium, albumin, aniongap, chloride, white blood cell count(WBC), red blood cell count(RBC), platelet count, and blood phosphorus.Figure 1 Lasso regression-based variable screening. A. Variation characteristics of variable coefficients; B. The process of selecting the optimal value of the parameter λ in the lasso regression model is carried out by the cross-validation method

Cox regression analysis of the 11 independent risk factors revealed all variables to be statistically significant (P < 0.05). SHAP analysis identified the most important variables: age, albumin, red blood cell count, blood phosphorus, and blood chloride.

A Cox regression model was constructed based on the five identified risk factors, and a nomogram was developed to visualize pre-dialysis mortality risk. In the validation cohort, the model achieved a C-index of 0.734 (95% CI: 0.709–0.760).Figure 2 Nomogram for predicting the risk of death at 1-, 2- and 3-year in pre-dialysis CKD patients

ROC analysis showed that the areas under the curve (AUCs) for predicting 1, 2, and 3-year mortality in the validation cohort were 0.832, 0.799, and 0.792, respectively.Figure 3 ROC curves of the model in the training set for predicting the mortality at 1-, 2-, and 3-year.

Calibration curves indicated only minor deviations between predicted and observed probabilities, suggesting good agreement between predicted risks and actual outcomes.

We developed and validated a simple five-variable Cox regression model to predict mortality in pre-dialysis CKD patients. The nomogram demonstrated good discriminative ability and calibration, suggesting that it could serve as a practical tool for individualized risk assessment and clinical decision-making in this population.

 

Kewords