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Predicting palliative care needs and mortality in end stage renal disease: use of an at-risk register
  1. Kennedy Feyi1,
  2. Sarah Klinger2,
  3. Georgina Pharro1,
  4. Liz Mcnally1,
  5. Ajith James1,
  6. Kate Gretton2 and
  7. Michael K Almond1
  1. 1Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK
  2. 2Department of Palliative Medicine, Southend University Hospital, Southend, Essex, UK
  1. Correspondence to Dr Sarah Elizabeth Klinger, Department of Palliative Medicine, Southend University Hospital, Southend, Essex SSO ORY, UK; sarah.klinger{at}


Introduction The Gold Standard Frameworks (GSF) Committee devised Prognostic Indicator Guidance in November 2007 to ‘aid identification of adult patients with advanced disease, in the last months or year of life, who are in need of supportive or palliative care’.

Methods This research used the GSF `surprise question' to formulate a list of patients predicted to die within 1 year with end stage renal failure and to establish the specificity and sensitivity of this register.

Results 58 patients were added to the list during the follow-up period of which 28 (48.3%) died during the same period giving an annual mortality of 32.2%. In comparison with the patients who died during the follow-up period but were not added to the at-risk register, those on the register had a much higher mortality rate (32.2% vs 7.8%). Identification of patients with chronic kidney disease and reduced life expectancy by this method appears to have a high sensitivity (66.7%) and specificity (77.9%). In particular, the negative predictive value for mortality for those on the at-risk register appears to be very high (88.3%), indicating the very low mortality among those not on the register.

Conclusions Patients with chronic kidney disease and a reduced life expectancy can be accurately identified by a multi-disciplinary team using the surprise trigger question with a relatively high sensitivity and specificity. The accurate identification of patients with reduced life expectancy allows appropriate end of life care planning to begin in keeping with patients' wishes and within published guidelines.

  • Prognosis
  • Renal failure
  • Supportive care
  • Clinical assessment

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