Aim We investigated two prognostic tools, the Supportive and Palliative Care Indicators Tool (SPICT) and the Surprise Question (SQ) that may assist decision making on initiating chronic dialysis vs Best Supportive Care.

Background Older age, frailty and comorbidities negatively impact on dialysis outcomes. There is increasing concern that the burden and complications of dialysis may harm both quality-of-life and longevity in patients with limited life-expectancy. The SPICT has been validated for prognostication for the final year-of-life. The SQ, ‘Would I be surprised if this patient died in the next 12 months?’ If SQ positive, then the clinician is not surprised if the patient dies within 12 months. We applied both tools retrospectively on patients commencing dialysis to examine their potential to assist the decision-making around dialysis initiation, versus a Best Supportive Care without dialysis.

Methods A single centre retrospective cohort pilot study of consecutive dialysis patients from two periods January-February 2023 &amp August-September 2023 to study two separate groups one aimed at 12 months and the other at 6 months respectively following initiation of chronic dialysis. Demographics, SPICT criteria, SQ along with outcome measures including tertiary hospital admissions, dialysis complications and mortality to date were collected from their hospital e-medical file.

Results There were a total of 23 patients with mean age was 67.5 ± 12.3 years, 83% male. There were 52% SPICT positive (n=12) and 43% of patients were SQ-positive (n=10). SPICT-positive patients had more hospital presentations in both 6 month (2.4 vs 1.1, p=0.002) and 12 month (5.6 vs 1.7, p=0.0001) groups. SPICT-positivity was associated with dialysis complications with a relative risk ratio of 14.4x (95% CI 1.4 – 150.8).

By comparison, SQ-positivity had less statistically significant results but did trend in the same direction with more hospital presentations in both the 6 month (2.4 vs 1.4, p value 0.35), and 12 month groups (4.6 vs 1.8, p value 0.07). Similarly, SQ positivity was associated with a relative risk ratio of 5x (95% CI 0.8 – 30.5) but did not reach statistical significance. All deaths were SPICT positive and SQ positive (n=2) with ≥ 20% annualised mortality predicted by both tools.

Conclusions Positivity with both tools suggested poorer dialysis outcomes and predicted higher mortality. SPICT appeared better than SQ in terms of predicting complications arising from dialysis. The SPICT tool prognostication may assist with patient selection and shared decision making regarding chronic dialysis vs supportive care in end-stage renal failure.