Prediction of mortality among patients with chronic kidney disease: A systematic review

Abstract

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.

TGF-β/Smad Signaling Pathway in Tubulointerstitial Fibrosis

“…Chronic kidney disease (CKD) has been recognized as a major public health problem worldwide and the global increase in CKD is associated with the increase in the prevalence of diabetes, hypertension, obesity, and aging ( Webster et al, 2017 ; Hansrivijit et al, 2021 ). Recent data showed that global prevalence of CKD was estimated to be between 11% and 13% in 2016 ( Hill et al, 2016 ).…”

Proanthocyanidins Protect Against Cadmium-Induced Diabetic Nephropathy Through p38 MAPK and Keap1/Nrf2 Signaling Pathways

“…Diabetic nephropathy (DN) is the most devastating complication of diabetes mellitus that causes significant morbidity and mortality ( Zoja et al, 2020 ). It is gradually becoming a leading cause of end-stage renal disease ( Duran-Salgado and Rubio-Guerra, 2014 ; Hansrivijit et al, 2021 ). Epidemiological studies reveal that more than 25% of patients with diabetes suffer from DN ( Reidy et al, 2014 ), which is characterized by a series of renal abnormalities including mesangial expansion, basement membrane thickening, tubulointerstitial fibrosis, and glomerulosclerosis ( Reidy et al, 2014 ; Li et al, 2021 ; Medina Rangel et al, 2021 ).…”

Recent advances of gut microbiota in chronic kidney disease patients

“…Chronic kidney disease (CKD) is a major public health problem worldwide [1][2][3]. According to the Kidney Disease Outcomes Quality Initiative, CKD is divided into five stages.…”