Introduction: Several scoring systems are used to provide prognostic estimates of mortality among patients admitted to the intensive care unit (ICU) but do not account for baseline kidney function.This systematic review and meta-analysis evaluates the performance of commonly used ICU scoring systems in patients with non-dialysis chronic kidney disease (CKD), end-stage kidney disease (ESKD) on maintenance dialysis, and kidney transplant recipients. Methods:We searched Ovid Medline, Embase, and Scopus from inception through October 10, 2024, to identify observational studies reporting the prognostic performance of ICU scoring systems for mortality in patients with pre-existing kidney disease, analyzed independently or compared with a general ICU population.Results: Twelve studies involving 578,027 patients met inclusion criteria, evaluating five ICU scoring systems (SOFA, APACHE II/III, SAPS II/III).Most studies involved patients with ESKD on maintenance dialysis and kidney transplant recipients; data on patients with non-dialysis CKD were very limited.For ESKD on maintenance dialysis, the area under the receiver operating characteristic curve (AUROC) showed excellent discrimination for all ICU scoring systems.However, discrimination was consistently lower in ESKD when compared with general ICU population, and calibration metrics showed consistent overestimation of mortality risk in ESKD.Among kidney transplant recipients, scoring systems displayed consistently poor discrimination, for both SAPS III and SOFA, with variable calibration metrics.J o u r n a l P r e -p r o o f This subgroup includes both acute-on-chronic kidney disease (not on dialysis at baseline) and normal kidney function as defined by normal baseline creatinine levels ( 90 mL/min/1.73m 2 ) 41,59 .*Non-ESKD = Individuals with or without CKD but not on maintenance dialysis and not having received a kidney transplant
El-wadia et al. (Wed,) studied this question.