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Seminars in Dialysis Jan 2021Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart... (Meta-Analysis)
Meta-Analysis Review
Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a meta-analysis investigating the relationship between CRT(D)/ICD and renal insufficiency. Cochrane Library, Web of Science, Embase, and Pubmed were systematically searched from inception to 29 October 2019. We included studies that report all-cause mortality of patients with renal insufficiency who received CRT(D)/ICD therapy. Twenty-six studies (n = 119,263) were included, exploring the relationship between CRT(D)/ICD and renal insufficiency from two aspects: (1) Compared with ICD-only, CRT(D) was associated with lower risk of all-cause mortality in CKD patients (odds ratios (OR) = 0.67; 95% confidence interval (CI), 0.60 to 0.75). For non-primary prevention (secondary prevention or both), the analysis revealed a lower risk of all-cause mortality in the ICD group than in the no-ICD group (OR = 0.47; 95% CI, 0.40 to 0.55). (2) CKD increased all-cause mortality in comparison with control group (OR = 2.12; 95% CI, 1.85 to 2.44), and so did dialysis (OR = 2.53; 95% CI, 2.34 to 2.73). Furthermore, compared with CKD3 (eGFR: 30-59 ml/min/1.73 m ), CKD4/5 (eGFR <30 ml/min/1.73 m ) was observed to have a significantly higher risk of all-cause mortality (OR = 2.70; 95% CI, 1.93 to 3.80). This review shows a clear association between CRT(D)/ICD and renal insufficiency in the aspect of all-cause mortality, and may provide a reference for the clinical application of CRT(D)/ICD.
Topics: Cardiac Resynchronization Therapy; Defibrillators, Implantable; Heart Failure; Humans; Renal Dialysis; Renal Insufficiency; Risk Factors; Treatment Outcome
PubMed: 33296540
DOI: 10.1111/sdi.12937 -
Journal of Advanced Nursing Oct 2023To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. (Meta-Analysis)
Meta-Analysis Review
AIMS
To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies.
DESIGN
Systematic review and meta-analysis about observational studies.
DATA SOURCES
Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021.
REVIEW METHODS
Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta-analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software.
RESULTS
Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta-analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%.
CONCLUSION
The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis-related factors.
IMPACT
This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk.
NO PATIENT OR PUBLIC CONTRIBUTION
This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public.
Topics: Humans; Female; Prevalence; Cognitive Dysfunction; Renal Dialysis; Risk Factors; Hypertension
PubMed: 37357980
DOI: 10.1111/jan.15746 -
World Neurosurgery Feb 2023Dialysis disequilibrium syndrome is a rare, well-known, potentially life-threatening complication of renal replacement therapy (RRT), often involving cerebral edema and... (Review)
Review
Dialysis Disequilibrium Syndrome and Intracranial Pressure Fluctuations in Neurosurgical Patients Undergoing Renal Replacement Therapy: Systematic Review and Pooled Analysis.
BACKGROUND
Dialysis disequilibrium syndrome is a rare, well-known, potentially life-threatening complication of renal replacement therapy (RRT), often involving cerebral edema and increased intracranial pressure (ICP). However, the impact of RRT on ICP and rate of dialysis disequilibrium syndrome in neurosurgical patients have not been systematically assessed.
METHODS
In February 2022, a systematic review following PRISMA guidelines was conducted using various combinations of 9 keywords in the MEDLINE database. Eleven papers were selected. Individual patient data were extracted, pooled, and analyzed.
RESULTS
Fifty-eight patients, 44 men and 14 women with a mean age of 48 years (6-78 years), were analyzed. Neurosurgical conditions included the following: spontaneous intracranial hemorrhage (n = 27), traumatic brain injury (n = 16), ischemic stroke/anoxic brain injury (n = 6), intracranial tumor (n = 6), and others (n = 3). Neurosurgical interventions included the following: craniotomy/craniectomy (n = 23), external ventricular drain or ICP monitor placement (n = 16), and burr hole or twist drill craniostomy (n = 4). Intermittent dialysis was used in 33 patients, continuous RRT in 20, and a combination thereof in 4. During RRT, ICP increased in 35 patients (60.3%), remained unchanged in 20, and decreased in 3. Thirty-four patients (65.4%) died. Intermittent dialysis was associated with increased ICP (73% vs. 37.5%, P = 0.01) and mortality (75% vs. 39.1%, P = 0.01).
CONCLUSIONS
In neurosurgical patients, ICP increases during RRT are common, affecting up to 60%, and potentially life-threatening, with mortality rates as high as 65%. The use of a continuous rather than intermittent RRT technique may reduce the risk of this complication. Prospective studies are warranted.
Topics: Male; Humans; Female; Middle Aged; Renal Dialysis; Continuous Renal Replacement Therapy; Intracranial Pressure; Acute Kidney Injury; Renal Replacement Therapy; Intracranial Hypertension
PubMed: 36494069
DOI: 10.1016/j.wneu.2022.11.142 -
BMC Nephrology Mar 2015Patient registries have great potential for providing data that describe disease burden, treatments, and outcomes; which can be used to improve patient care. Many renal... (Review)
Review
BACKGROUND
Patient registries have great potential for providing data that describe disease burden, treatments, and outcomes; which can be used to improve patient care. Many renal registries exist, but a central repository of their scope, quality, and accessibility is lacking. The objective of this study was to identify and assess worldwide renal registries reporting on renal replacement therapy and compile a list of those most suitable for use by a broad range of researchers.
METHODS
Renal registries were identified through a systematic literature review and internet research. Inclusion criteria included information on dialysis use (yes/no), patient counts ≥300, and evidence of activity between June 2007 and June 2012. Public availability of information on dialysis modality, outcomes, and patient characteristics as well as accessibility of patient-level data for external research were evaluated.
RESULTS
Of 144 identified renal registries, 48 met inclusion criteria, 23 of which were from Europe. Public accessibility to annual reports, publications, or basic data was good for 17 registries and moderate for 22. Patient-level data were available to external researchers either directly or through application and review (which may include usage fees) for 13 of the 48 registries, and were inaccessible or accessibility was unknown for 25.
CONCLUSIONS
The lack of available data, particularly in emerging economies, leaves information gaps about health care and outcomes for patients with renal disease. Effective multistakeholder collaborations could help to develop renal registries where they are absent, or enhance data collection and dissemination for currently existing registries to improve patient care.
Topics: Female; Global Health; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Prevalence; Registries; Renal Dialysis; Survival Analysis
PubMed: 25886028
DOI: 10.1186/s12882-015-0028-2 -
PloS One 2014A well-functioning arteriovenous fistula (AVF) is the best modality for vascular access in patients with end-stage renal disease (ESRD) requiring haemodialysis (HD).... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
A well-functioning arteriovenous fistula (AVF) is the best modality for vascular access in patients with end-stage renal disease (ESRD) requiring haemodialysis (HD). However, AVFs' main disadvantage is the high rate of maturation failure, with approximately one third (20%-50%) not maturing into useful access. This review examine the use of Far-Infra Red therapy in an attempt to enhance both primary (unassisted) and secondary (assisted) patency rates for AVF in dialysis and pre-dialysis patients.
METHOD
We performed an online search for observational studies and randomised controlled trials (RCTs) that evaluated FIR in patients with AVF. Eligible studies compared FIR with control treatment and reported at least one outcome measure relating to access survival. Primary patency and secondary patency rates were the main outcomes of interest.
RESULTS
Four RCTs (666 patients) were included. Unassisted patency assessed in 610 patients, and was significantly better among those who received FIR (228/311) compared to (185/299) controls (pooled risk ratio of 1.23 [1.12-1.35], p = 0.00001). In addition, the two studies which reported secondary patency rates showed significant difference in favour of FIR therapy--160/168 patients--compared to 140/163 controls (pooled risk ratio of 1.11 [1.04-1.19], p = 0.003).
CONCLUSION
FIR therapy may positively influence the complex process of AVF maturation improving both primary and secondary patency rates. However blinded RCTs performed by investigators with no commercial ties to FIR therapy technologies are needed.
Topics: Arteriovenous Shunt, Surgical; Humans; Infrared Rays; Kidney Failure, Chronic; Observational Studies as Topic; Randomized Controlled Trials as Topic; Renal Dialysis
PubMed: 25115802
DOI: 10.1371/journal.pone.0104931 -
International Urology and Nephrology Mar 2019The reported association between individual indicators of socioeconomic status (SES) and mortality in dialysis patients was inconsistent in previous studies. We... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The reported association between individual indicators of socioeconomic status (SES) and mortality in dialysis patients was inconsistent in previous studies. We performed a meta-analysis to identify the association between SES and mortality of dialysis population.
METHODS
The meta-analysis was conducted in accordance with MOOSE guidelines. Cohorts evaluating the association between SES indicators (income, education and occupation) and mortality in dialysis patients were included. Random-effects models were used to pool the adjusted relative risk (RR) from individual studies. Heterogeneity was assessed by Cochrane's Q and the I statistic. Subgroup analyses and sensitivity analyses were performed to identify sources of heterogeneity and to evaluate the robustness of findings.
RESULTS
Fourteen studies were finally included. In hemodialysis patients, increased mortality was associated with lower level of income (RR = 1.08, 95%CI [1.01-1.16], P = 0.035; I = 87.9%, P < 0.001) and occupation (RR = 1.63, 95%CI [1.11-2.38], P = 0.013; I = 0.0%, P = 0.601). However, no significant association was identified for education (RR = 1.43, 95%CI [0.92-2.25]; P = 0.112; I = 68.3%,P = 0.001). In patients receiving peritoneal dialysis, lower level of income (RR = 1.80, 95%CI [1.12-2.88],P = 0.015; I = 75.9%, P = 0.042), education (RR = 1.27, 95%CI [1.13-1.43], P < 0.001; I = 0.0%, P = 0.684), and occupation (RR = 3.42, 95% CI [1.35-8.70], P = 0.010) were risk factors for increased mortality. Subgroup analysis showed the association between SES indicators and mortality in hemodialysis differed according to geographic locations and study designs.
CONCLUSION
Lower SES (measured by income, education, and occupation) tends to be associated with higher mortality in patients receiving maintenance dialysis. But the magnitude of the associations varied for different individual indicators of SES.
Topics: Educational Status; Humans; Income; Kidney Failure, Chronic; Occupations; Peritoneal Dialysis; Renal Dialysis; Risk Factors; Socioeconomic Factors
PubMed: 30689180
DOI: 10.1007/s11255-019-02078-5 -
Psychological Medicine Jun 2020Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory...
Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory cytokines, complement and autoantibodies against CNS epitopes have recently been associated with psychosis. Related concepts in previous decades led to several clinical trials of dialysis and plasmapheresis as treatments for schizophrenia. These trials may have relevance for the current understanding of schizophrenia. We aimed to identify whether dialysis or plasmapheresis are beneficial interventions in schizophrenia. We conducted a systematic search in major electronic databases for high-quality studies (double-blinded randomised trials with sham controls) applying either haemodialysis or plasmapheresis as an intervention in patients with schizophrenia, published in English from the start of records until September 2018. We found nine studies meeting inclusion criteria, reporting on 105 patients in total who received either sham or active intervention. One out of eight studies reported a beneficial effect of haemodialysis on schizophrenia, one a detrimental effect and six no effect. The sole trial of plasmapheresis found it to be ineffective. Adverse events were reported in 23% of patients. Studies were at unclear or high risk of bias. It is unlikely that haemodialysis is a beneficial treatment in schizophrenia, although the studies were of small size and could not consider potential subgroups. Plasmapheresis was only addressed by one study and warrants further exploration as a treatment modality in schizophrenia.
Topics: Autoimmune Diseases; Bias; Humans; Plasmapheresis; Randomized Controlled Trials as Topic; Renal Dialysis; Schizophrenia
PubMed: 32404224
DOI: 10.1017/S0033291720001324 -
Nephrology, Dialysis, Transplantation :... Oct 2023The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The impact of home-based exercise on physical performance and quality of life (QoL) in patients on maintenance dialysis has not yet been fully established.
METHODS
We searched four large electronic databases to identify randomized controlled trials (RCTs) reporting the impact of home-based exercise interventions vs. usual care or intradialytic exercise interventions, on physical performance and QoL in patients on dialysis. The meta-analysis was performed using fixed effects modeling.
RESULTS
We included 12 unique RCTs involving 791 patients of various ages on maintenance dialysis. Home-based exercise interventions were associated with an improvement of walking speed at the 6 Minutes Walking Test [6MWT; nine RCTs; pooled weighted mean differences (WMD): 33.7 m, 95% confidence interval (CI) 22.8-44.5; P < 0.001; I2 = 0%) and in aerobic capacity as assessed by the peak oxygen consumption (VO2 peak; 3 RCTs; pooled WMD: 2.04 ml/kg/min, 95% CI 0.25-3.83; P = 0.03; I2 = 0%). They were also associated with improved QoL, as assessed by the Short Form (36) Health (SF-36) score. Stratifying the RCTs by control groups, no significant difference was found between home-based exercise and intradialytic exercise interventions. Funnel plots did not reveal any significant publication bias.
CONCLUSIONS
Our systematic review and meta-analysis showed that home-based exercise interventions for 3-6 months were associated with significant improvements in physical performance in patients on maintenance dialysis. However, further RCTs with a longer follow-up should be conducted to assess the safety, adherence, feasibility, and effects on QoL of home-based exercise programs in dialysis patients.
Topics: Humans; Renal Dialysis; Randomized Controlled Trials as Topic; Exercise; Exercise Therapy; Quality of Life
PubMed: 37202219
DOI: 10.1093/ndt/gfad102 -
American Journal of Kidney Diseases :... Dec 2016We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis.
STUDY DESIGN
Systematic review and meta-analysis of cohort studies.
SETTING & POPULATION
Dialysis patients.
SELECTION CRITERIA FOR STUDIES
We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015.
PREDICTORS
Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T) and thyroxine (T) levels.
OUTCOMES
All-cause and cardiovascular mortality.
RESULTS
12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T level, and low T level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T and T levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively.
LIMITATIONS
Fewer studies reporting on T and thyrotropin outcomes.
CONCLUSIONS
In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
Topics: Cohort Studies; Humans; Renal Dialysis; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland
PubMed: 27596516
DOI: 10.1053/j.ajkd.2016.06.023 -
Annals of Palliative Medicine Feb 2022At present, peritoneal dialysis (PD) is widely used in the clinical treatment of patients with end-stage renal disease (ESRD), and comparison of the efficacy of PD and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
At present, peritoneal dialysis (PD) is widely used in the clinical treatment of patients with end-stage renal disease (ESRD), and comparison of the efficacy of PD and hemodialysis (HD) in the treatment of diabetic kidney disease (DKD) has been reported in a few clinical studies.
METHODS
In this study, "dialysis", "peritoneal dialysis", "renal replacement therapy", "end-stage renal disease", "diabetic renal disease", and "efficacy and safety" were used as search terms in Chinese and English databases. According to RevMan 5.3 and Stata 13 software provided by the Cochrane Collaboration, a meta-analysis was performed.
RESULTS
Four randomized controlled trials were included in this study, and 3 trials described the randomization method, 3 described allocation concealment in detail, and 2 used the blinding method. Compared with the HD treatment in the control group, the PD treatment in the experimental group can significantly reduce the hemoglobin of patients with end-stage DKD [Mean difference (MD) =-0.13, 95% confidence interval (CI): -0.21 to -0.04; P=0.003<0.05] and Albumin level (MD = -0.10, 95% CI: -0.16 to -0.04; P=0.002<0.05). Compared with the control group, the PD treatment in the experimental group significantly increased the serum creatinine and blood urea nitrogen levels in patients with end-stage DKD, but there was no significant difference in the effects of PD and HD treatment on serum creatinine levels (MD =-0.30, 95% CI: -0.77 to 0.16; P=0.20>0.05), (MD =1.93, 95% CI: -2.65 to 6.51; P=-0.41>0.05). In addition, PD treatment in the experimental group significantly increased the probability of malignant tumors in patients with end-stage DKD [odds ratio (OR) =1.86, 95% CI: 1.64 to 2.10; P<0.00001], and the difference was significant.
DISCUSSIONS
This study used meta-analysis to confirm that PD can significantly improve the renal function of patients with end-stage DKD, but it can also increase the probability of protein loss and complications.
Topics: Diabetes Mellitus; Diabetic Nephropathies; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Randomized Controlled Trials as Topic; Renal Dialysis
PubMed: 35249347
DOI: 10.21037/apm-22-50