TY - JOUR
T1 - Prediction of risk of death for patients starting dialysis
T2 - A systematic review and meta-analysis
AU - Anderson, Ryan T.
AU - Cleek, Hailey
AU - Pajouhi, Atieh S.
AU - Bellolio, M. Fernanda
AU - Mayukha, Ananya
AU - Hart, Allyson
AU - Hickson, La Tonya J.
AU - Feely, Molly A.
AU - Wilson, Michael E.
AU - Connolly, Ryan M.Giddings
AU - Erwin, Patricia J.
AU - Majzoub, Abdul M.
AU - Tangri, Navdeep
AU - Thorsteinsdottir, Bjorg
N1 - Funding Information:
This project was supported by a Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery award (to Thor-steinsdottir and Hickson); the Norman S. Coplon Extramural Grant Program of Satellite Healthcare, a not-for-profit renal care provider (to Thorsteinsdottir and Hickson); National Institute on Aging grant K23AG051679 (to Thorsteinsdottir); and National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK109134 (to Hickson). Additional support was provided by the National Center for Advancing Translational Sciences grant UL1 TR000135.
Publisher Copyright:
© 2019 by the American Society of Nephrology.
PY - 2019/8/7
Y1 - 2019/8/7
N2 - 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.
AB - 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.
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U2 - 10.2215/CJN.00050119
DO - 10.2215/CJN.00050119
M3 - Article
C2 - 31362990
AN - SCOPUS:85071345952
SN - 1555-9041
VL - 14
SP - 1213
EP - 1227
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 8
ER -