Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2017
Reliability and Utility of the Surprise Question in CKD Stages 4 to 5.
Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Policy strategies to enhance uptake of conservative kidney management in advanced chronic kidney disease: a systematic review and meta-analysis.BMC nephrology · 2025Pooled it
- The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis.BMJ supportive & palliative care · 2024Pooled it
- External validation of a prognostic model in routine practice for short- and long-term survival in peritoneal dialysis.Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis · 2026Article
- Analysis of mortality predictors in a 1-year cohort of neuropalliative care patients.Arquivos de neuro-psiquiatria · 2026Article
- Population Health Management for Improving Kidney Health Outcomes.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025Article
- Charlson comorbidity index and all-cause mortality in patients with delayed hemodialysis initiation: a prospective cohort study.BMC nephrology · 2025Article
- Dialysis in the Elderly: A Practical Guide for the Clinician.International journal of nephrology · 2025Review
- The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS).Kidney medicine · 2024Article
- Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations.Journal of nephrology · 2024Review
- Article
- Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention.Pilot and feasibility studies · 2022Article
- Advance Care Planning Documentation and Intensity of Care at the End of Life for Adults With Congestive Heart Failure, Chronic Kidney Disease, and Both Illnesses.Journal of pain and symptom management · 2022Article
- Patient participation and associated factors in the discussions on do-not-attempt-resuscitation and end-of-life disclosure: a retrospective chart review study.BMC palliative care · 2021Article
- Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD.American journal of nephrology · 2020Observational
- The Surprise Question and Self-Rated Health Are Useful Screens for Frailty and Disability in Older Adults with Chronic Kidney Disease.Journal of palliative medicine · 2019Article
- Serious Illness Treatment Preferences for Older Adults with Advanced CKD.Journal of the American Society of Nephrology : JASN · 2019Article
- Health Outcome Priorities of Older Adults with Advanced CKD and Concordance with Their Nephrology Providers' Perceptions.Journal of the American Society of Nephrology : JASN · 2018Article
- The Surprise Question as a Prognostic Tool #360.Journal of palliative medicine · 2018Article
- Neuropalliative Care: A Practical Guide for the Neurologist.Seminars in neurology · 2018Review
- Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5.BMC palliative care · 2018Observational
Corrections and comments
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Authors and funding
13 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundPrognostic uncertainty is one barrier to engaging in goals-of-care discussions in chronic kidney disease (CKD). The surprise question ("Would you be surprised if this patient died in the next 12 months?") is a tool to assist in prognostication. However, it has not been studied in non-dialysis-dependent CKD and its reliability is unknown. STUDY
designObservational study. SETTING &
participants388 patients at least 60 years of age with non-dialysis-dependent CKD stages 4 to 5 who were seen at an outpatient nephrology clinic. PREDICTOR: Trinary (ie, Yes, Neutral, or No) and binary (Yes or No) surprise question response. OUTCOMES: Mortality, test-retest reliability, and blinded inter-rater reliability. MEASUREMENTS: Baseline comorbid conditions, Charlson Comorbidity Index, cause of CKD, and baseline laboratory values (ie, serum creatinine/estimated glomerular filtration rate, serum albumin, and hemoglobin).
resultsMedian patient age was 71 years with median follow-up of 1.4 years, during which time 52 (13%) patients died. Using the trinary surprise question, providers responded Yes, Neutral, and No for 202 (52%), 80 (21%), and 106 (27%) patients, respectively. About 5%, 15%, and 27% of Yes, Neutral, and No patients died, respectively (P<0.001). Trinary surprise question inter-rater reliability was 0.58 (95% CI, 0.42-0.72), and test-retest reliability was 0.63 (95% CI, 0.54-0.72). The trinary surprise question No response had sensitivity and specificity of 55% and 76%, respectively (95% CIs, 38%-71% and 71%-80%, respectively). The binary surprise question had sensitivity of 66% (95% CI, 49%-80%; P=0.3 vs trinary), but lower specificity of 68% (95% CI, 63%-73%; P=0.02 vs trinary). LIMITATIONS: Single center, small number of deaths.
conclusionsThe surprise question associates with mortality in CKD stages 4 to 5 and demonstrates moderate to good reliability. Future studies should examine how best to deploy the surprise question to facilitate advance care planning in advanced non-dialysis-dependent CKD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.