P0805SURPRISE QUESTION IN ADVANCED CHRONIC KIDNEY DISEASE

Abstract Background and Aims Nowadays, patients with end-stage chronic renal disease (ESRD) are initiating dialysis at more advanced ages and having multiple comorbidities. Since the initiation of dialysis in the elderly may not result in increased survival or quality of life, it would be useful to define prognostic criteria for those patients. We aim to evaluate the utility of the surprise question (“Would I be surprised if this patient died in the next 12 months?”) as a predictor of survival in elderly patients in advanced stages of chronic kidney disease (CKD). Method Retrospective cohort study of patients elder than 70 years with CKD stages 4 to 5 according to the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) who attended the CKD information consultation between March 2017 and November 2018. The answer to the surprise question was registered during that office visit. Demographic, clinical and laboratory data (including serum albumin) were analyzed and Charlson Comorbidity Index (CCI) was calculated. Continuous variables are presented as means (±SD) or medians (IQ range), according to normality, and categorical variables as frequencies. Comparisons between groups were made using Student’s T-test and Pearson Chi-squared test. Survival analysis was conducted using Kaplan-Meier test and Cox proportional hazard model. STATA software was used and a p<0.05 was considered significant. Results Of the 60 patients selected, 22 (36.7%) were female, 59 (98%) were white and the median age was 78.6±6.3 years. Half of these patients had diabetes mellitus with end-organ damage and 57% suffered from congestive heart failure. The response to the surprise question was “yes” in 31 (51.7%) patients and “no” in 29 (48.3%) patients. We did not find clinical or demographic differences among these groups. The patients were followed for 26 (20-31) months, during which 19 deaths occurred, 4 (21%) in the SQ-yes group and 15 (79%) in the SQ-no group. The response to the surprise question was associated with patients’ survival (KM – p=0.0009), with a positive and negative predictive values of 79% and 66%, respectively. The multivariate analysis (age, sex, race, serum albumin and CCI) showed that the answer to the SQ is an independent predictor of mortality (HR 0.27 [IC 0.08-0.86]). Conclusion The SQ seems to be a good predictor of survival in elderly patients in advanced stages of CKD and can be used to assess their prognosis in order to help deciding whether the patient is a good candidate to initiate dialysis or not.