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Kidney Week

Abstract: PO0221

Performance of Validated Indices for Risk of Death for Patients with AKI Requiring Dialysis: A Systematic Review and Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Thorsteinsdottir, Bjoerg, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Pajouhi, Atieh, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Gunaratne, Madugodaralalage Dona K., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Feely, Molly A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hickson, LaTonya J., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hart, Allyson, Hennepin Healthcare, Minneapolis, Minnesota, United States
Background

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high morbidity and mortality. Multiple mortality indices have been developed, however, the most optimal index for predicting survival in AKI requiring RRT is unknown.
Objective: To assess performance of validated mortality indices for patients with AKI requiring RRT.

Methods

Design, setting, participants and measurements: Systematic review and meta-analysis following the PRISMA guidelines. Multiple databases (MEDLINE, Embase, Central Register of Controlled Trials, Cochrane, and Scopus) were searched from inception to Jan 31 2019.
Selection Criteria: Studies evaluating the performance of validated mortality indices in adult AKI patients requiring RRT were included. Studies not separating AKI patients requiring RRT or used validated indices only as covariates were excluded. Articles were screened and data extracted in duplicate. Risk of bias was assessed using the PROBAST tool. Pre-planned random effects meta-analysis was performed stratified by index, population, renal specific vs. general mortality index, and predictive window.

Results

Of 10,115 articles screened, 37 (2 development, 21 validation and 14 combined) were included totaling 35 different indices tested in 11,142 patients. Average age was 60.8 years with 34.6% women. Predictive windows ranged from ICU to 60-day survival. The most used indices were APACHE II, Liano, SOFA, and SAPS II. Meta-analysis by index showed overall discrimination area under the curve (AUC) of 0.69 (95% CI 0.67-0.71) with high heterogeneity (I2 =82.37) with highest AUC for APACHE III 0.73(0.66-0.8) Liano 0.73(0.68-0.78) and MODS 0.71(0.62-0.80).

Conclusion

There is insufficient discrimination and heterogeneity in the performance of prognostic indices for AKI requiring RRT. Additional studies are needed to optimize mortality prediction in this population.

Funding

  • NIDDK Support