Urgent-start peritoneal dialysis in chronic kidney disease patients: A systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis

2020 ◽  
pp. 089686082091871
Author(s):  
Guo Xieyi ◽  
Tang Xiaohong ◽  
Wu Xiaofang ◽  
Li Zi
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Exit Site Infection ◽  
Quality Of Evidence ◽  
Significant Difference

An increasing number of studies have focused on whether peritoneal dialysis (PD) can be used for the urgent initiation of dialysis in patients with chronic kidney disease (CKD). We performed this systematic review and meta-analysis to evaluate the feasibility and safety of urgent-start PD compared with those of planned PD and urgent-start hemodialysis (HD) in this population. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and China National Knowledge Infrastructure (CNKI) were searched for relevant studies. Conference abstracts were also searched in relevant websites. The meta-analysis was performed using RevMan 5.3 software. A total of 15 trials involving 2426 participants were identified. The quality of the included studies was fair, but the quality of evidence was very low. Unadjusted meta-analysis showed that urgent-start PD had significantly higher mortality than planned PD, while adjusted meta-analysis did not show a significant difference. Higher incident of leakage and catheter mechanical dysfunction were observed in urgent-start PD. However, peritonitis, exit-site infection, or PD technique survival were comparable between urgent-start and planned PD. The all-cause mortality was comparable in urgent-start PD and urgent-start HD. Bacteremia was significantly lower in the urgent-start PD group than with urgent-start HD. Based on limited evidences, PD may be a viable alternative to HD for CKD patients requiring urgent-start dialysis. Because of the inconsistent results and the low quality of evidence, a definitive conclusion could not be drawn for whether urgent-start PD was comparable with planned PD. Therefore, high-quality and large-scale studies are needed in the future.

Comparison between Intravenous Iron and Oral Iron Preparations for the Treatment of Anemia of Chronic Kidney Disease - A Systematic Review and Meta-Analysis

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3748-3748
Author(s):  
Anat Gafter-Gvili ◽  
Benaya Rozen-Zvi ◽  
Mical Paul ◽  
Leonard Leibovici ◽  
Gafter Uzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Oral Iron ◽  
Dialysis Patients ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Iron Preparation ◽  
Iv Iron

Abstract Background: There is confounding data regarding the best method of iron supplementation in chronic kidney disease (CKD), without a consistent approach in clinical practice. Objectives: To evaluate the efficacy and safety of intravenous (IV) iron versus oral iron in patients treated for anemia of CKD. Methods: Systematic review and meta-analysis of randomized controlled trials comparing IV iron preparation with oral iron preparation for the treatment of anemia in patients with CKD (stage III, IV and V). The Cochrane Library, MEDLINE, conference proceedings and references were searched until 2007. Primary outcomes: absolute hemoglobin (Hb) level or change in Hb level from baseline at two months or at end of study; all-cause mortality. Secondary outcomes: need for renal replacement therapy (RRT) in predialysis patient and adverse events. Weighted mean differences (WMD) for outcomes with continuous variables and relative risks (RR) for dichotomous outcomes with 95% confidence intervals (CI) were estimated and pooled. Results: Our search yielded 11 trials which compared IV iron preparations (iron sucrose, iron gluconate or iron dextran) to oral iron. Compared to oral iron, there was a significant rise in Hb level in the IV iron treated hemodialysis patients (WMD 1.17; 95%CI 0.19–2.15, fig). Significant heterogeneity was observed due to different baseline Hb values and baseline iron status, different dosages of oral iron, and different dosages of erythropoiesis stimulating agents (ESA). For predialysis patients, there was a small but significant difference in the Hb level favoring the IV iron group (WMD 0.28; 95% CI 0.15–0.4, fig). For both groups effect estimates were not influenced by ESA administration. In predialysis patients, there was no significant difference in the risk for requiring RRT during the trial between the different groups (RR 0.63; 95%CI 0.25–1.65). Data on all-cause mortality were sparse (RR 0.54; 95%CI 0.09–3.13, 3 trials) and there was no difference in adverse events (RR 0.9; 95%CI 0.65–1.24) between the IV and oral treated patients. However, discontinuations of treatment were more common (RR 3.27; 95%CI 1.15–9.26) for the IV iron treated patients. Conclusions: Our review demonstrates that dialysis patients treated with IV iron have better Hb response than patients treated with oral iron. For predialysis patients, this effect is very small. IV iron should be preferred in the treatment of anemia in dialysis patients. In predialysis patients the slight advantage in Hb response should be weighed against the inconvenience and cost of IV iron treatment.

scholarly journals Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Chengyu Hou ◽  
Feng Liu ◽  
Chengbin Liu
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Third Molar ◽  
Pooled Analysis ◽  
Third Molar Surgery ◽  
Quality Of Evidence ◽  
Pain Scores ◽  
Significant Difference ◽  
Mandibular Third Molar Surgery

Objective: The study aimed to review evidence on the efficacy of submucosal (SM) administration vs. intravenous (IV) or intramuscular (IM) route of injections of dexamethasone for improving outcomes after mandibular third molar surgery.Methods: PubMed, Embase, CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) up to 20th May 2021. Early (2–3 days) and late (7 days) outcomes were compared between SM vs. IV or IM dexamethasone. Quality of evidence was assessed based on GRADE.Results: Thirteen trials were included in the systematic review and 10 in the meta-analysis. Meta-analysis indicated a significant reduction in early pain with IV dexamethasone but no such difference for late pain compared to the SM group. There was no difference in early and late swelling scores between the SM and IV groups. Pooled analysis indicated no significant difference in early and late trismus between SM and IV groups. Comparing SM with IM dexamethasone, there was no significant difference in early and late pain scores. Swelling in the early and late postoperative periods was not significantly different between the two groups. There was no significant difference in early and late trismus between SM and IM groups. The quality of evidence was low for all outcomes.Conclusion: Low-quality evidence suggests that SM infiltration of dexamethasone results in similar outcomes as compared to IV or IM administration of the drug after third molar surgeries. Further high-quality RCTs are needed to corroborate the current conclusions.

scholarly journals Efficacy and Safety of Daprodustat for Anemia Therapy in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Qiyan Zheng ◽  
Yahui Wang ◽  
Huisheng Yang ◽  
Luying Sun ◽  
Xinwen Fu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Binding Capacity ◽  
Meta Analysis ◽  
Transferrin Saturation ◽  
Placebo Treatment ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Significant Difference

Objective: Daprodustat is a novel oral agent in treating anemia of chronic kidney disease (CKD), and several clinical trials have been conducted to compare daprodustat with recombinant human erythropoietin (rhEPO) or placebo. Our systematic review aimed to investigate the efficacy and safety of daprodustat for anemia treatment in both dialysis-dependent (DD) and non-dialysis-dependent (NDD) patients.Methods: Six databases were searched for randomized controlled trials (RCTs) reporting daprodustat vs. rhEPO or placebo for anemia patients in CKD. The outcome indicators were focused on hemoglobin (Hb), ferritin, transferrin saturation (TSAT), total iron-binding capacity (TIBC), vascular endothelial growth factor (VEGF), and serious adverse events (SAEs).Results: Eight eligible studies with 1,516 participants were included. For both NDD and DD patients, changes in Hb levels from baseline were significantly higher in daprodustat group than that in the placebo (mean difference (MD) = 1.73, [95% confidence interval (CI), 0.34 to 3.12], p = 0.01; MD = 1.88, [95% CI, 0.68 to 3.09], p = 0.002; respectively), and there was no significant difference between daprodustat and rhEPO group (MD = 0.05, [95% CI, −0.49 to 0.59], p = 0.86; MD = 0.12, [95% CI, −0.28 to 0.52], p = 0.55; respectively). The indexes of iron metabolism were improved significantly in the daprodustat group compared to placebo- or rhEPO-treated patients, while there was no similar change in terms of TSAT for DD patients. Furthermore, no trend of increasing plasma VEGF was observed in daprodustat-treated subjects. As for safety, there was no significant difference in the incidence of SAEs between daprodustat and placebo treatment, while the incidence of SAEs in the daprodustat group was significantly lower than that in the rhEPO group.Conclusion: Daprodustat was efficacious and well tolerated for anemia in both NDD and DD patients in the short term based on current RCTs. And daprodustat may become an effective alternative for treatment of anemia with CKD. Since the application of daprodustat is still under exploration, future researches should consider the limitations of our study to evaluate the value of daprodustat.

scholarly journals A Systematic Review and Meta-Analysis of Utility-Based Quality of Life in Chronic Kidney Disease Treatments

PLoS Medicine ◽  
2012 ◽  
Vol 9 (9) ◽  
pp. e1001307 ◽  
Author(s):  
Melanie Wyld ◽  
Rachael Lisa Morton ◽  
Andrew Hayen ◽  
Kirsten Howard ◽  
Angela Claire Webster
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis

Home-Based Exercise for People With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Renata Valle Pedroso ◽  
Miguel Adriano Sanchez-Lastra ◽  
Laura Iglesias Comesaña ◽  
Carlos Ayán
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Home Based ◽  
The Impact ◽  
At Home

Background: Exercise performed at home could be a useful therapy for people with chronic kidney disease. This systematic review and meta-analysis aimed at describing the characteristics, main findings, methodological quality, and adherence rate reported in the existent randomized controlled trials that have provided information regarding the impact of home-based exercise programs on people with chronic kidney disease. Methods: Electronic databases (MEDLINE/PubMed, SPORTDiscus, Scopus, and CENTRAL) were searched up to April 2021, using the keywords: “Exercise”; “Home”; “Kidney Disease.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adopted. Jadad scale and Cochrane’s tool were used to assess the methodological quality and risk of bias. Results: Out of the 14 studies finally selected, 11 were included in the meta-analysis and most presented high methodological quality. The meta-analysis showed significant effects of home-based exercise on fitness and quality of life, but a little impact on renal function. Although exercise performed at home was mostly feasible and safe, adherence was not high and a considerable number of dropouts were observed. Conclusion: Home-based exercise has positive effects on the fitness’ level and on the quality of life on people with chronic kidney disease. Future studies are needed to identify whether exercise performed at home is a better physical therapy option than center-based exercise.

scholarly journals Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044357
Author(s):  
Caio Chaves Guimaraes ◽  
Luciane Cruz Lopes ◽  
Cristiane de Cássia Bergamaschi ◽  
Juliana Cama Ramacciato ◽  
Marcus Tolentino Silva ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Intervention Group ◽  
Local Anaesthetics ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quality Of Evidence ◽  
Dental Procedures

ObjectivesThere is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD.DesignSystematic review and meta-analysis.MethodsWe have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsTen RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference −0.95, 95% CI −1.35 to −0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile.ConclusionsThe results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results.Protocol registrationPROSPERO (CRD42016045421).

scholarly journals Outcomes of coronavirus 2019 infection in patients with chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199886
Author(s):  
Yi-Chih Lin ◽  
Tai-Shuan Lai ◽  
Shuei-Liong Lin ◽  
Yung-Ming Chen ◽  
Tzong-Shinn Chu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Case Series ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
All Cause Mortality

Background: Information on coronavirus disease 2019 (COVID-19) infection in patients with chronic kidney disease (CKD) remains limited. To understand the influence of COVID-19 infection in patients with pre-existing CKD, we conducted a systematic review and meta-analysis to evaluate and compare the risks of all-cause mortality, hospitalization, and critical progression between patients with and without CKD. Methods: We selected randomized controlled trials (RCTs), prospective or retrospective observational, case-control, cross-sectional, and case-series studies analyzing outcomes of COVID-19 infection in patients with pre-existing CKD from the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases published on the Internet before 16 July 2020. Results: A total of 27 studies comprising 77,856 patients with COVID-19 infection was identified; 3922 patients with pre-existing CKD were assigned CKD group, and 73,934 patients were assigned to the non-CKD group. The pooled analysis showed that patients with CKD had a significantly higher risk of all-cause mortality and hospitalization than those without CKD [odds ratio (OR) 2.25, 95% confidence interval (CI) 1.91–2.66, p < 0.001; OR 4.29, 95% CI 2.93–6.28, p < 0.001; respectively]. Patients with CKD had a higher risk of critically ill conditions than those without CKD in the pooled analysis of studies with multivariable adjustment (adjusted OR 2.12, 95% CI 0.95–4.77, p = 0.07) and in the analysis of all included studies (OR 1.27, 95% CI 0.71–2.26, p = 0.41), but both analyses did not attain statistical significance. Conclusion: COVID-19 infected patients with CKD had significantly increased risks of all-cause mortality and hospitalization compared with those without CKD.

scholarly journals Hyperuricemia, urate-lowering therapy, and kidney outcomes: a systematic review and meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110166
Author(s):  
Gaurav Sharma ◽  
Abhishek Dubey ◽  
Nilesh Nolkha ◽  
Jasvinder A. Singh
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Kidney Failure ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register

Background: Contradictory evidence exists for association of hyperuricemia and kidney function. To investigate the association of hyperuricemia and kidney function decline (hyperuricemia question) and effect of urate-lowering therapies (ULTs) on kidney function (ULT question), we performed a systematic review and meta-analysis. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and CINAHL were searched from inception to July 2020. We selected observational studies for the hyperuricemia question and controlled trials for the ULT question. Two investigators independently assessed study eligibility and abstracted the data. Risk of bias was assessed using the Newcastle–Ottawa Scale and Cochrane risk of bias tool. Meta-analysis was done using the inverse variance method and random effect model. We estimated odds ratio (OR), hazard ratio (HR), risk ratio (RR), and the mean difference (MD). Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Of 12,037 studies screened, 131 studies with 3,414,226 patients were included. Hyperuricemia was associated with a significant risk of rapid estimated glomerula filtration rate (eGFR) decline ⩾3 ml/min per 1.73 m2 per year (OR 1.38, 95% CI 1.20–1.59; low certainty), albuminuria (OR/HR 1.94, 95% CI 1.34–2.79; very low certainty), chronic kidney disease (OR/HR 2.13, 95% CI 1.74–2.61; very low certainty), and kidney failure (HR 1.53, 95% CI 1.18–1.99; very low certainty). Compared with control, ULT use for ⩾1 year was associated with significantly more improved eGFR (MD 1.81 ml/min per 1.73 m2, 95% CI 0.26–3.35; very low certainty), serum creatinine (MD −0.33 mg/dl, 95% CI −0.47 to −0.19; low certainty), and proteinuria (MD −5.44 mg/day, 95% CI −8.49 to −2.39; low certainty), but no difference in kidney failure. Conclusion: Hyperuricemia is associated with worsening eGFR, albuminuria, chronic kidney disease, and kidney failure. ULT use for ⩾1 year may improve kidney function. Registration: The protocol was registered at PROSPERO database, CRD42015013859.

scholarly journals Human Milk–Derived Fortifiers Compared with Bovine Milk–Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 11 (5) ◽  
pp. 1325-1333 ◽  
Author(s):  
Anitha Ananthan ◽  
Haribalakrishna Balasubramanian ◽  
Shripada Rao ◽  
Sanjay Patole
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Bovine Milk ◽  
Quality Of Evidence ◽  
Lower Weight ◽  
Significant Difference ◽  
Lower Weight Gain

ABSTRACT This systematic review assessed outcomes after using human milk–derived fortifier (HMF) compared with bovine milk–derived fortifier (BMF) in preterm infants. Six randomized controlled trials (RCTs) were included. Meta-analysis using a random-effects model showed the following results: 1) lower risk of necrotizing enterocolitis (NEC; ≥Stage II) (RR: 0.38; 95% CI: 0.15, 0.95; P = 0.04, I2 = 9%; n = 334, 4 RCTs) and surgical NEC (RR: 0.13; 95% CI: 0.02, 0.67; P = 0.02, I2 = 0%; n = 209, 3 RCTs) in the HMF group; 2) no significant difference in mortality (RR: 0.40; 95% CI: 0.14, 1.15; P = 0.09, I2 = 0%; n = 334, 4 RCTs); 3) lower weight gain in the HMF group [mean difference (MD) = −1.08 g · kg−1 · d−1; 95% CI: −1.96, −0.21 g · kg−1 · d−1; P = 0.02, I2 = 0%; n = 241, 4 RCTs]; 4) no differences for length (MD = −0.11 cm/wk; 95% CI: −0.26, 0.04 cm/wk; P = 0.14, I2 = 68%) and head circumference (MD = −0.02 cm/wk; 95% CI: −0.08, 0.05 cm/wk; P = 0.59, I2 = 23%); and 5) no significant difference in late-onset sepsis (RR: 0.96; 95% CI: 0.56, 1.67; P = 0.90, I2 = 63%; n = 334, 4 RCTs). The beneficial effects of HMF for NEC were no longer significant in sensitivity analyses after excluding studies with high risk of bias. Quality of evidence as per Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis was low to very low, and hence the confidence in these results is low. In summary, fortification of milk in preterm infants with HMF compared with BMF decreased the risk of NEC but was associated with lower weight gain. Given the low quality of evidence, adequately powered and well-designed RCTs without the influence of industry are required in this field.

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