Introduction:
In 2016, the European Renal Best Practice (ERBP) group published a guideline on the management of older adults with advanced chronic kidney disease (CKD). Two risk scores were highlighted: the Bansal score for mortality, and the Kidney Failure Risk Equation (KFRE) for estimating progression to end-stage kidney disease (ESRD). Our group, as part of the ERBP team, aimed to apply these risk prediction tools in a cohort of older adults with eGFR < 45 ml/min/1.73 m².

Material and methods:
This retrospective study included adults aged ≥ 65 years with CKD stage 3b-4, evaluated at a Romanian Outpatient Nephrology Department between October 2016 and October 2018. The Bansal score was calculated for all subjects and the KFRE was then used in the low mortality risk group. Outcomes were death or the initiation of dialysis. These outcomes were used to compare the difference between the estimated trajectory and the observed clinical course of patients. Patients were followed up until September 2019.

Results:
From the total population (N = 958 patients), more than half (N1 = 548, 57.2%) had a high mortality risk. In the remaining group with low mortality risk (N2 = 410, 42.8%), 75.4% had a low risk of progression to ESRD. Observed events consisted of 164 deaths and 31 dialysis initiations. We found similar death rates in the two groups (high versus low predicted mortality risk). There was no difference in the rate of dialysis initiation between subjects with a high or low predicted risk of progression to ESRD.

Conclusions:
Risk prognostication for death and ESRD did not correspond to the observed clinical course of our older patients with advanced CKD.