Published online Jul 25, 2021. doi: 10.5527/wjn.v10.i4.59
Peer-review started: March 21, 2021
First decision: May 6, 2021
Revised: May 11, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: July 25, 2021
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.
To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis.
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.
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.
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.
Core Tip: Although the current evidence has shown that several clinical factors are associated with mortality in chronic kidney disease (CKD), the accuracy of mortality prediction has not been clearly demonstrated. Our systematic review of studies that reported prognostic mortality factors using area under the receiver operating characteristic curve analysis in CKD patients provides an accuracy measurement. A total of 18 studies were identified. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had end-stage kidney disease. Of 24 predictive factors, none were considered outstanding for mortality prediction. A total of seven predictive factors were identified as excellent. Our review summarizes the current accuracy of prognostic factors for CKD mortality.