Prediction of risk of death for patients starting dialysis: A systematic review and meta-analysis

Ryan T. Anderson, Hailey Cleek, Atieh S. Pajouhi, M. Fernanda Bellolio, Ananya Mayukha, Allyson Hart, La Tonya J. Hickson, Molly A. Feely, Michael E. Wilson, Ryan M.Giddings Connolly, Patricia J. Erwin, Abdul M. Majzoub, Navdeep Tangri, Bjorg Thorsteinsdottir

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background and objectives Dialysis is a preference-sensitive decision where prognosis may play an important role. Although patients desire risk prediction, nephrologists are wary of sharing this information. We reviewed the performance of prognostic indices for patients starting dialysis to facilitate bedside translation. Design, setting, participants, & measurements Systematic review and meta-analysis following the PRISMA guidelines. We searched Ovid MEDLINE, Ovid Embase, Ovid Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus for eligible studies of patients starting dialysis published frominceptiontoDecember 31, 2018.SelectionCriteria:Articlesdescribingvalidatedprognostic indices predicting mortality at the start of dialysis. We excluded studies limited to prevalent dialysis patients, AKI and studies excludingmortality in the first 1-3months. Two reviewers independently screened abstracts, performed full text assessmentof inclusioncriteria andextracted: studydesign, setting,populationdemographics, indexperformance and risk of bias. Pre-planned random effects meta-analysis was performed stratified by index and predictive window to reduce heterogeneity. ResultsOf 12,132 articles screened and 214 reviewed in full text, 36 studies were included describing 32 prognostic indices. Predictive windows ranged from 3 months to 10 years, cohort sizes from 46 to 52,796. Meta-analysis showed discrimination area under the curve (AUC) of 0.71 (95% confidence interval, 0.69 to 073) with high heterogeneity (I2=99.12). Meta-analysis by index showed highest AUC for The Obi, Ivory, and Charlson comorbidity index (CCI)=0.74, also CCI was the most commonly used (ten studies). Other commonly used indices were Kahn-Wright index (eight studies, AUC 0.68), Hemmelgarn modification of the CCI (six studies, AUC0.66) andREINindex (five studies,AUC0.69).Of the indices, tenhave beenvalidatedexternally, 16 internally and nine were pre-existing validated indices. Limitations include heterogeneity and exclusion of large cohort studies in prevalent patients. Conclusions Several well validated indices with good discrimination are available for predicting survival at dialysis start.

Original languageEnglish (US)
Pages (from-to)1213-1227
Number of pages15
JournalClinical Journal of the American Society of Nephrology
Issue number8
StatePublished - Aug 7 2019

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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