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This study aimed to develop a clinical risk model for predicting 6-month mortality after dialysis initiation in older Korean hemodialysis patients. Methods: We analyzed data from incident hemodialysis patients aged &gt;70 years from the Korean Society of Geriatric Nephrology (KSGN) database. A prediction model was developed using multivariate logistic regression analysis and externally validated with independent datasets. Results: Among 1,751 incident hemodialysis patients, the 6-month mortality rate was 15.5%. Using multivariate logistic analysis, we constructed the KSGN score as an independent risk factor for 6-month mortality, and its components and score are as follows: old age at dialysis initiation (\u226585 years, score 2); hypertension and renovascular disease as a primary etiology of end-stage kidney disease (ESKD) (score 1); malignancy history (yes, score 1); low serum albumin (&lt;3.5 g\/dL, score 1); hypertension treatment (yes, score \u20131); prepared vascular access on maintenance dialysis (arteriovenous fistula\/arteriovenous graft, score \u20133). In the development cohort, the area under the curve (AUC) for the KSGN score was significantly higher than the Alberta Wick\u2019s score (0.707 vs. 0.683, p = 0.001). In the validation cohort, the KSGN score\u2019s performance was comparable to existing models. Conclusion: The KSGN score may be a valuable tool for predicting early mortality after dialysis initiation in older patients with ESKD, aiding in decision-making and management regarding dialysis initiation.<\/jats:p>","DOI":"10.23876\/j.krcp.23.224","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T23:54:23Z","timestamp":1745538863000},"page":"664-678","update-policy":"https:\/\/doi.org\/10.23876\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prediction model for 6-month mortality in incident older hemodialysis patients in South Korea"],"prefix":"10.23876","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2662-2898","authenticated-orcid":true,"given":"Woo 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