KARNOFSKY PERFORMANCE SCALE AS A PROGNOSTIC MARKER IN POPULATIONS WITH CHRONIC KIDNEY DISEASE: SYSTEMATIC AND IMPLICATIONS FOR OLDER ADULTS ON HEMODIALYSIS AND IN PALLIATIVE CARE

Abstract

This systematic review aimed to evaluate the association between the Karnofsky Performance Scale and prognostic outcomes in populations with Chronic Kidney Disease, discussing its clinical implications for older adults with advanced CKD undergoing hemodialysis and eligible for palliative care. Literature searches were conducted in PubMed, SciELO and LILACS, restricted to studies published between 2017 and 2025, yielding 258 initial records. After removal of duplicates, title and abstract screening, and full-text assessment according to the PRISMA 2020 flow, 4 observational studies were included. The qualitative synthesis showed a consistent association between lower KPS scores and worse outcomes, including poorer quality of life, higher mortality and increased risk of unfavorable outcomes among kidney transplant candidates. Although the overall risk of bias was judged as low using the Newcastle–Ottawa Scale, heterogeneity in study designs and outcomes limited the possibility of a formal meta-analysis and calls for cautious interpretation. The findings suggest that KPS can be routinely incorporated into the assessment of elderly patients on renal replacement therapy to identify palliative care needs and support shared decision-making about continuation, intensification or withdrawal of dialysis.