Development and Validation of a Nomogram for Predicting the 6-Month Survival Rate in Incident Hemodialysis Patients

Background The all-cause mortality in hemodialysis(HD) patients is higher than in the general population and the first 6 months after initiating dialysis is an important transitional period for new HD patients. The aim of this study was to develop and validate a nomogram for predicting the 6-month survival rate among HD patients. Methods We developed a prediction model based on a training cohort of 679 HD patients. Multivariate Cox regression analyses were performed to identify predictive factors, followed by establishment of a nomogram. Next, performance of the nomogram was assessed using the C-index and calibration plots. The nomogram was validated through applying discrimination and calibration to an additional cohort of 173 HD patients. Results During a follow-up period of six months, there were 47 and 12 deaths in the training cohort and validation cohort, respectively, with a mortality rate of 7.3% and 6.9%, respectively. The score included five commonly available predictors: age, temporary dialysis catheter, intradialytic hypotension, use of ACEi or ARB, and use of loop diuretics. The score revealed good discrimination in the training cohort [C-index 0.775(0.693-0.857)] and validation cohort [C-index 0.758(0.677-0.836)], whereas the calibration plots showed good calibration, indicating suitable performance of the nomogram model. The total score point was then divided into two risk classifications: low risk (0-90 points) and high risk (≥ 91 points). Results showed that all-cause mortality was significantly different in HD patients in the high-risk group compared to the low-risk group. Conclusions This nomogram can accurately predict the 6-month survival rate for HD patients, and thus it can be used in clinical decision-making.