Identifying key predictors of mortality in young patients on chronic haemodialysis-a machine learning approach.
BACKGROUND
The mortality risk remains significant in paediatric and adult patients on chronic haemodialysis (HD) treatment. We aimed to identify factors associated with mortality in patients who started HD as children and continued HD as adults.


METHODS
The data originated from a cohort of patients <30 years of age who started HD in childhood (≤19 years) on thrice-weekly HD in outpatient DaVita dialysis centres between 2004 and 2016. Patients with at least 5 years of follow-up since the initiation of HD or death within 5 years were included; 105 variables relating to demographics, HD treatment and laboratory measurements were evaluated as predictors of 5-year mortality utilizing a machine learning approach (random forest).


RESULTS
A total of 363 patients were included in the analysis, with 84 patients having started HD at <12 years of age. Low albumin and elevated lactate dehydrogenase (LDH) were the two most important predictors of 5-year mortality. Other predictors included elevated red blood cell distribution width or blood pressure and decreased red blood cell count, haemoglobin, albumin:globulin ratio, ultrafiltration rate, z-score weight for age or single-pool Kt/V (below target). Mortality was predicted with an accuracy of 81%.


CONCLUSIONS
Mortality in paediatric and young adult patients on chronic HD is associated with multifactorial markers of nutrition, inflammation, anaemia and dialysis dose. This highlights the importance of multimodal intervention strategies besides adequate HD treatment as determined by Kt/V alone. The association with elevated LDH was not previously reported and may indicate the relevance of blood-membrane interactions, organ malperfusion or haematologic and metabolic changes during maintenance HD in this population.
['Gotta|Verena|V|', 'Tancev|Georgi|G|', 'Marsenic|Olivera|O|', 'Vogt|Julia E|JE|', 'Pfister|Marc|M|']
D000293:Adolescent D000328:Adult D000740:Anemia D015415:Biomarkers D001835:Body Weight D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D007249:Inflammation D007676:Kidney Failure, Chronic D000069550:Machine Learning D008297:Male D009752:Nutritional Status D011379:Prognosis D006435:Renal Dialysis D012189:Retrospective Studies D015996:Survival Rate D055815:Young Adult
paediatrics chronic haemodialysis ultrafiltration anaemia dialysis adequacy survival analysis