Kidney Medicine (Jul 2025)

Predicting Hospitalization and Related Outcomes in Advanced Chronic Kidney Disease: A Systematic Review, External Validation, and Development Study

  • Roemer J. Janse,
  • Jet Milders,
  • Joris I. Rotmans,
  • Fergus J. Caskey,
  • Marie Evans,
  • Claudia Torino,
  • Maciej Szymczak,
  • Christiane Drechsler,
  • Christoph Wanner,
  • Maria Pippias,
  • Antonio Vilasi,
  • Vianda S. Stel,
  • Nicholas C. Chesnaye,
  • Kitty J. Jager,
  • Friedo W. Dekker,
  • Merel van Diepen,
  • Andreas Schneider,
  • Anke Torp,
  • Beate Iwig,
  • Boris Perras,
  • Christian Marx,
  • Christiane Drechsler,
  • Christof Blaser,
  • Christoph Wanner,
  • Claudia Emde,
  • Detlef Krieter,
  • Dunja Fuchs,
  • Ellen Irmler,
  • Eva Platen,
  • Hans Schmidt-Gürtler,
  • Hendrik Schlee,
  • Holger Naujoks,
  • Ines Schlee,
  • Sabine Cäsar,
  • Joachim Beige,
  • Jochen Röthele,
  • Justyna Mazur,
  • Kai Hahn,
  • Katja Blouin,
  • Katrin Neumeier,
  • Kirsten Anding-Rost,
  • Lothar Schramm,
  • Monika Hopf,
  • Nadja Wuttke,
  • Nikolaus Frischmuth,
  • Pawlos Ichtiaris,
  • Petra Kirste,
  • Petra Schulz,
  • Sabine Aign,
  • Sandra Biribauer,
  • Sherin Manan,
  • Silke Röser,
  • Stefan Heidenreich,
  • Stephanie Palm,
  • Susanne Schwedler,
  • Sylke Delrieux,
  • Sylvia Renker,
  • Sylvia Schättel,
  • Theresa Stephan,
  • Thomas Schmiedeke,
  • Thomas Weinreich,
  • Til Leimbach,
  • Torsten Stövesand,
  • Udo Bahner,
  • Wolfgang Seeger,
  • Adamasco Cupisti,
  • Adelia Sagliocca,
  • Alberto Ferraro,
  • Alessandra Mele,
  • Alessandro Naticchia,
  • Alex Còsaro,
  • Andrea Ranghino,
  • Andrea Stucchi,
  • Angelo Pignataro,
  • Antonella De Blasio,
  • Antonello Pani,
  • Aris Tsalouichos,
  • Bellasi Antonio,
  • Biagio Raffaele Di Iorio,
  • Butti Alessandra,
  • Cataldo Abaterusso,
  • Chiara Somma,
  • Claudia D’alessandro,
  • Claudia Torino,
  • Claudia Zullo,
  • Claudio Pozzi,
  • Daniela Bergamo,
  • Daniele Ciurlino,
  • Daria Motta,
  • Domenico Russo,
  • Enrico Favaro,
  • Federica Vigotti,
  • Ferruccio Ansali,
  • Ferruccio Conte,
  • Francesca Cianciotta,
  • Francesca Giacchino,
  • Francesco Cappellaio,
  • Francesco Pizzarelli,
  • Gaetano Greco,
  • Gaetana Porto,
  • Giada Bigatti,
  • Giancarlo Marinangeli,
  • Gianfranca Cabiddu,
  • Giordano Fumagalli,
  • Giorgia Caloro,
  • Giorgina Piccoli,
  • Giovanbattista Capasso,
  • Giovanni Gambaro,
  • Giuliana Tognarelli,
  • Giuseppe Bonforte,
  • Giuseppe Conte,
  • Giuseppe Toscano,
  • Goffredo Del Rosso,
  • Irene Capizzi,
  • Ivano Baragetti,
  • Lamberto Oldrizzi,
  • Loreto Gesualdo,
  • Luigi Biancone,
  • Manuela Magnano,
  • Marco Ricardi,
  • Maria Di Bari,
  • Maria Laudato,
  • Maria Luisa Sirico,
  • Martina Ferraresi,
  • Michele Provenzano,
  • Moreno Malaguti,
  • Nicola Palmieri,
  • Paola Murrone,
  • Pietro Cirillo,
  • Pietro Dattolo,
  • Pina Acampora,
  • Rita Nigro,
  • Roberto Boero,
  • Roberto Scarpioni,
  • Rosa Sicoli,
  • Rosella Malandra,
  • Silvana Savoldi,
  • Silvio Bertoli,
  • Silvio Borrelli,
  • Stefania Maxia,
  • Stefano Maffei,
  • Stefano Mangano,
  • Teresa Cicchetti,
  • Tiziana Rappa,
  • Valentina Palazzo,
  • Walter De Simone,
  • Anita Schrander,
  • Bastiaan van Dam,
  • Carl Siegert,
  • Carlo Gaillard,
  • Charles Beerenhout,
  • Cornelis Verburgh,
  • Cynthia Janmaat,
  • Ellen Hoogeveen,
  • Ewout Hoorn,
  • Friedo Dekker,
  • Johannes Boots,
  • Henk Boom,
  • Jan-Willem Eijgenraam,
  • Jeroen Kooman,
  • Joris Rotmans,
  • Kitty Jager,
  • Liffert Vogt,
  • Maarten Raasveld,
  • Marc Vervloet,
  • Marjolijn van Buren,
  • Merel van Diepen,
  • Nicholas Chesnaye,
  • Paul Leurs,
  • Pauline Voskamp,
  • Peter Blankestijn,
  • Sadie van Esch,
  • Siska Boorsma,
  • Stefan Berger,
  • Constantijn Konings,
  • Zeynep Aydin,
  • Aleksandra Musiała,
  • Anna Szymczak,
  • Ewelina Olczyk,
  • Hanna Augustyniak-Bartosik,
  • Ilona Miśkowiec-Wiśniewska,
  • Jacek Manitius,
  • Joanna Pondel,
  • Kamila Jędrzejak,
  • Katarzyna Nowańska,
  • Łukasz Nowak,
  • Maciej Szymczak,
  • Magdalena Durlik,
  • Ś zyszkowska Dorota,
  • Teresa Nieszporek,
  • Zbigniew Heleniak,
  • Andreas Jonsson,
  • Anna-Lena Blom,
  • Björn Rogland,
  • Carin Wallquist,
  • Denes Vargas,
  • Emöke Dimény,
  • Fredrik Sundelin,
  • Fredrik Uhlin,
  • Gunilla Welander,
  • Isabel Bascaran Hernandez,
  • Knut-Christian Gröntoft,
  • Maria Stendahl,
  • Maria Svensson,
  • Marie Evans,
  • Olof Heimburger,
  • Pavlos Kashioulis,
  • Stefan Melander,
  • Tora Almquist,
  • Ulrika Jensen,
  • Alistair Woodman,
  • Anna McKeever,
  • Asad Ullah,
  • Barbara McLaren,
  • Camille Harron,
  • Carla Barrett,
  • Charlotte O’Toole,
  • Christina Summersgill,
  • Colin Geddes,
  • Deborah Glowski,
  • Deborah McGlynn,
  • Dympna Sands,
  • Fergus Caskey,
  • Geena Roy,
  • Gillian Hirst,
  • Hayley King,
  • Helen McNally,
  • Houda Masri-Senghor,
  • Hugh Murtagh,
  • Hugh Rayner,
  • Jane Turner,
  • Joanne Wilcox,
  • Jocelyn Berdeprado,
  • Jonathan Wong,
  • Joyce Banda,
  • Kirsteen Jones,
  • Lesley Haydock,
  • Lily Wilkinson,
  • Margaret Carmody,
  • Maria Weetman,
  • Martin Joinson,
  • Mary Dutton,
  • Michael Matthews,
  • Neal Morgan,
  • Nina Bleakley,
  • Paul Cockwell,
  • Paul Roderick,
  • Phil Mason,
  • Philip Kalra,
  • Rincy Sajith,
  • Sally Chapman,
  • Santee Navjee,
  • Sarah Crosbie,
  • Sharon Brown,
  • Sheila Tickle,
  • Suresh Mathavakkannan,
  • Ying Kuan

DOI
https://doi.org/10.1016/j.xkme.2025.101016
Journal volume & issue
Vol. 7, no. 7
p. 101016

Abstract

Read online

Rationale & Objective: Hospitalization is common in patients with advanced chronic kidney disease (CKD). Predicting hospitalization and related outcomes would be beneficial for hospitals and patients. Therefore, we aimed to (1) give an overview of current prediction models for hospitalization, length of stay, and readmission in patients with advanced CKD; (2) externally validate these models; and (3) develop a new model if no valid models were identified. Study Design: Systematic review, development, and external validation study. Setting & Participants: We were interested in prediction models of hospitalization, length of stay, or readmission for patients with advanced CKD. Our available development and validation data consisted of hemodialysis, peritoneal dialysis, and advanced CKD patients not receiving dialysis from a Dutch dialysis and European advanced CKD cohort. Selection Criteria for Studies: We systematically searched PubMed. Studies had to intentionally develop, validate, or update a prediction model in adults with CKD. Analytical Approach: We used the PROBAST for risk of bias assessment. Identified models were externally validated on model discrimination (C-statistic) and calibration (calibration plot, slope, and calibration-in-the-large). We developed a Fine-Gray model for hospitalization within 1 year in patients initiating hemodialysis, accounting for the competing risk of death. Results: We identified 45 models in 8 studies. The majority were of low quality with a high risk of bias. Due to underreporting and population-specific predictors, we could only validate 3 models. These were poorly calibrated and had poor discrimination. Using multiple modeling strategies, an adequate new model could not be developed. Limitations: The outcome hospitalization might be too heterogeneous, and we did not have all relevant predictors available. Conclusions: Hospitalizations are important but difficult to predict for patients with advanced CKD. An improved prediction model should be developed, for example, using a more specific outcome (eg, cardiovascular hospitalizations) and more predictors (eg, patient-reported outcome measures). Plain-Language Summary: Hospitalizations often occur in patients with advanced chronic kidney disease. By predicting hospitalization and related outcomes, patients can better prepare for the future and cope with their disease. Therefore, we searched existing literature for existing methods to predict hospitalizations and related outcomes. Although many algorithms exist, they are often not available for use or are not reliable. We then developed our own algorithm to predict hospitalization in the coming year. However, it also did not predict reliably. In this study, we summarize what failed in existing prediction algorithms, what we learned from predicting hospitalization ourselves, and how to proceed to allow reliable predictions of hospitalizations.

Keywords