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
Processing time: 137 Days and 14.4 Hours
Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Understanding the accuracy of mortality risk factors in CKD patients could mitigate death.
Evidence has shown that several clinical factors are associated with mortality in CKD patients using regression analyses. However, the accuracy of these mortality predictive factors has not been clearly demonstrated.
To establish the accuracy of mortality predictive factors among CKD patients by utilizing the area under the receiver operating characteristic curve (AUC) analysis.
Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible articles through January 2021. Only studies that reported their mortality predictive factors with AUC and 95% confidence interval were included. These factors were classified as acceptable, excellent, or outstanding based on their AUC.
Of 1759 citations, a total of 18 studies (n = 14579) were included in the systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 hemodialysis, 370 peritoneal dialysis, and 11217 undifferentiated modalities of dialysis). Of 24 predictive factors, none were considered outstanding for mortality prediction. A total of seven predictive factors (N-terminal pro-brain natriuretic peptide, brain natriuretic peptide, soluble urokinase plasminogen activator receptor, 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.
This study determined several mortality risk factors for CKD patients that were deemed acceptable or excellent. Echocardiography is an important tool for mortality prognostication in CKD patients.
The results of this study provide a preliminary perspective on the importance of identifying better prognostic factors for mortality in CKD patients. There is a lack of predictive risk factors with an AUC greater than 0.90. Currently identified mortality risk factors can be combined to create a risk calculator for CKD patients, which could be subsequently validated in future research.