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Predator because it works with his ulti (predator damage applies on lowest HP). And for better ganks.
Starting items :
I don't upgrade the talisman. It's a super cost-efficient item on its own and Stalker's Blade is hardly an improvement for 650 gold. Archangel's Staff is better than Enchantment: Runic Echoes since Karthus needs a big mana pool. With RE only I run out of mana in teamfights, Defile is 78 mana per second. And buying both items delays other items too much.
Early game :
Tear + catalyst gives infinite mana and HP sustain, so you can farm jungle as much as you want. Boots for predator ganks.
Mid game :
I always go Arch before completing RoA. Reason is that RoA doesn't give more sustain than catalyst (seeing Karth's mana costs). And Arch gives much faster farming speed (the CDR is the major factor).
Late game standard Karthus items (dcap, zhonya/veil, void, liandry...).
Skill build :
I always go wall level 2 for ganking bot lane. Level 3 I take Q or E depending on whether I want to clear raptors. Otherwise standard.
Clear speed is very fast. Can solo dragon. Ganks with predator are actually pretty good. Level 2 gank with wall is no joke, that slow is sick. Can counterjungle fast when enemy jungler is away/dead. You don't have the downside of laning mid against an assassin who can oneshot you, which is Karthus' biggest weakness.
But weak to invades. Can't 1v1 most junglers except the kiteable ones. Mostly a defensive playstyle of warding, pinging for help, and counterjungling the side where the enemy jungler isn't.
Overall I like it. New meta.