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Prediction of mortality among patients with chronic kidney disease: A systematic review
Panupong Hansrivijit1, Yi-Ju Chen1, Kriti Lnu1
1Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States.
Insights
Several factors accurately predict mortality in chronic kidney disease (CKD) patients. Echocardiography, including left atrial reservoir strain and systolic pulmonary artery pressure, is a key tool for prognostication.
Area of Science:
- Nephrology
- Cardiology
- Medical Statistics
Background:
- Chronic kidney disease (CKD) is a growing global health concern.
- While clinical factors are linked to CKD mortality, their predictive accuracy remains unclear.
- This study quantifies the predictive accuracy of various mortality risk factors in CKD.
Purpose of the Study:
- To assess the accuracy of mortality predictive factors in CKD patients.
- Utilize Area Under the Receiver Operating Characteristic Curve (AUC) analysis for accurate quantification.
- Identify key predictors for improved patient outcomes and risk stratification.
Main Methods:
- Systematic review of 18 observational studies (n=14,579) published up to January 2021.
- Included non-transplant CKD patients across all stages.
- Analyzed predictive factors using AUC and 95% confidence intervals, with established accuracy benchmarks.
Main Results:
- No single factor achieved outstanding mortality prediction accuracy (AUC > 0.90).
- Seven factors demonstrated excellent accuracy (AUC 0.80-0.89): NT-proBNP, BNP, suPAR, augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure.
- Seventeen factors showed acceptable accuracy (AUC 0.70-0.79).
Conclusions:
- Multiple factors effectively predict mortality in CKD patients.
- Echocardiography is crucial for prognostication, assessing parameters like left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.
- These findings aid in refining risk assessment and management strategies for CKD patients.
Background:
Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated.
Aim:
To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis.
Methods:
We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding.
Results:
Of 1759 citations, a total of 18 studies (n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous.
Conclusion:
Several factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.
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