-
American Journal of Kidney Diseases :... Dec 2015Serum parathyroid hormone (PTH), phosphorus, and calcium levels are surrogate outcomes that are central to the evaluation of drug treatments in chronic kidney disease... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Serum parathyroid hormone (PTH), phosphorus, and calcium levels are surrogate outcomes that are central to the evaluation of drug treatments in chronic kidney disease (CKD). This systematic review evaluates the evidence for the correlation between drug effects on biochemical (PTH, phosphorus, and calcium) and all-cause and cardiovascular mortality end points in adults with CKD.
STUDY DESIGN
Systematic review and meta-analysis.
SETTING & POPULATION
Adults with CKD.
SELECTION CRITERIA FOR STUDIES
Randomized trials reporting drug effects on biochemical and mortality end points.
INTERVENTION
Drug interventions with effects on serum PTH, phosphorus, and calcium levels, including vitamin D compounds, phosphate binders, cinacalcet, bisphosphonates, and calcitonin.
OUTCOMES
Correlation between drug effects on biochemical and all-cause and cardiovascular mortality.
RESULTS
28 studies (6,999 participants) reported both biochemical and mortality outcomes and were eligible for analysis. Associations between drug effects on surrogate biochemical end points and corresponding effects on mortality were weak and imprecise. All correlation coefficients were less than 0.70, and 95% credible intervals were generally wide and overlapped with zero, consistent with the possibility of no association. The exception was an inverse correlation between drug effects on serum PTH levels and all-cause mortality, which was nominally significant (-0.64; 95% credible interval, -0.85 to -0.15), but the strength of this association was very imprecise. Risk of bias within available trials was generally high, further reducing confidence in the summary correlations. Findings were robust to adjustment for age, baseline serum PTH level, allocation concealment, CKD stage, and drug class.
LIMITATIONS
Low power in analyses and combining evidence from many different drug comparisons with incomplete data across studies.
CONCLUSIONS
Drug effects on serum PTH, phosphorus, and calcium levels are weakly and imprecisely correlated with all-cause and cardiovascular death in the setting of CKD. Risks of mortality (patient-level outcome) cannot be inferred from treatment-induced changes in biochemical outcomes in people with CKD. Similarly, existing data do not exclude a mortality benefit with treatment. Trials need to address patient-centered outcomes to evaluate drug effectiveness in this setting.
Topics: Biomarkers; Calcium; Humans; Mortality; Parathyroid Hormone; Phosphorus; Renal Agents; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 26003472
DOI: 10.1053/j.ajkd.2015.03.036 -
International Journal of Hyperthermia :... 2021Microwave ablation (MWA) is used for the treatment of severe secondary hyperparathyroidism (SHPT), but its efficacy and safety still remained unclear. This study aimed... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Microwave ablation (MWA) is used for the treatment of severe secondary hyperparathyroidism (SHPT), but its efficacy and safety still remained unclear. This study aimed to investigate the efficacy and safety of ultrasound (US)-guided MWA in patients with SHPT.
METHODS
The PubMed, Cochrane library, Embase, China national knowledge infrastructure (CNKI) and Wanfang databases were searched to identify published studies that evaluated the efficacy and safety of US-guided MWA in patients with SHPT. The primary outcomes were parathyroid hormone (PTH), serum calcium and phosphorus levels.
RESULTS
A total of 26 studies with 932 patients were identified. The PTH levels showed significant reduction at 1 month [weighted mean difference (WMD) = 945.33, 95% CI: 797.15∼1093.52] and 6 months (WMD = 1,151.91, 95% CI: 990.93∼1312.89) after MWA of SHPT patients. The serum calcium (WMD = 0.39, 95% CI: 0.30 ∼ 0.48) and phosphorus levels (WMD = 0.64, 95% CI: 0.43 ∼ 0.85) showed significant reduction at 6 months after MWA of SHPT patients. The most common complications observed were hypocalcemia (35.2%) and transient hoarseness (9.2%). No other major complications or death occurred in our study patients.
CONCLUSION
These findings suggest MWA as a safe and effective minimally invasive technique for the management of SHPT. PTH, calcium, and phosphorus levels were significantly reduced at 1 and 6 months after MWA.
Topics: Ablation Techniques; Humans; Hyperparathyroidism, Secondary; Microwaves; Parathyroid Hormone; Ultrasonography, Interventional
PubMed: 34428994
DOI: 10.1080/02656736.2021.1965664 -
World Journal of Gastrointestinal... Feb 2023Post-hepatectomy liver failure (PHLF) is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection. Some...
BACKGROUND
Post-hepatectomy liver failure (PHLF) is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection. Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.
AIM
To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.
METHODS
This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. PubMed, Cochrane and Lippincott Williams & Wilkins databases were systematically searched up to March 31, 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF, overall postoperative morbidity and liver regeneration. The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.
RESULTS
After final assessment, nine studies (eight retrospective and one prospective cohort study) with 1677 patients were included in the systematic review. All selected studies scored ≥ 6 points according to the Newcastle-Ottawa Scale. Cutoff values of hypophosphatemia varied from < 1 mg/dL to ≤ 2.5 mg/dL in selected studies with ≤ 2.5 mg/dL being the most used defining value. Five studies analyzed PHLF, while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia. Only two of the selected studies analyzed postoperative liver regeneration, with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia. In three studies hypophosphatemia was associated with better postoperative outcomes, while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.
CONCLUSION
Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection. However, routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.
PubMed: 36896296
DOI: 10.4240/wjgs.v15.i2.249 -
The American Journal of Clinical... Nov 2016Dietary Reference Intakes (DRIs) are fundamental to inform national nutrition policy. However, a regular systematic review of the 51 nutrients that have DRIs has limited... (Review)
Review
BACKGROUND
Dietary Reference Intakes (DRIs) are fundamental to inform national nutrition policy. However, a regular systematic review of the 51 nutrients that have DRIs has limited feasibility, and many DRIs have not been reviewed in >15 y.
OBJECTIVE
To address this issue, individuals (nutrient review group) who were members of the Food and Nutrition Board developed a streamlined, evidence-based methodology that could be used to identify nutrients potentially in need of a systematic review.
DESIGN
The proposed methodology, termed an evidence scan, comprises several steps. First, an analytic framework is developed to identify markers of associations between intake of a nutrient and a corresponding clinical outcome. Next, the framework is used to direct the identification of keywords for a scan of published research that is potentially relevant to intake requirements or upper intake levels for a nutrient. Last, a panel of content experts selects the abstracts that are likely to be relevant and reviews the full publications. The results may be used to determine whether a revision of the nutrient's DRI is an immediate priority but would not supplant a comprehensive systematic evidence review.
RESULTS
To illustrate the process, 2 nutrients were selected as case studies: thiamin and phosphorus (DRIs were last set in 1998 and 1997, respectively). Using the evidence scan for thiamin, we identified 70 potentially relevant abstracts, of which 9 full publications were reviewed. For phosphorus, 127 potentially relevant abstracts were identified, and 29 full publications were reviewed.
CONCLUSIONS
From the review of these 2 nutrients, the nutrient review group concluded that there was insufficient new evidence to assign a high priority to a comprehensive systematic review for either thiamin or phosphorus. Evidence scanning is an efficient method of identifying DRI nutrients that are most in need of either a new or an updated systematic review.
Topics: Diet; Dose-Response Relationship, Drug; Evidence-Based Medicine; Humans; Nutrition Assessment; Nutrition Policy; Observational Studies as Topic; Phosphorus; Pilot Projects; Randomized Controlled Trials as Topic; Recommended Dietary Allowances; Risk Assessment; Thiamine
PubMed: 27733406
DOI: 10.3945/ajcn.115.128256 -
Frontiers in Plant Science 2022A discrete number of studies have been conducted on the effects of rhizobia (Rhz) inoculants, phosphorus (P) management, and combined application of Rhz and P fertilizer...
A discrete number of studies have been conducted on the effects of rhizobia (Rhz) inoculants, phosphorus (P) management, and combined application of Rhz and P fertilizer on the enhancement of grain legume yield across soils of Ghana and elsewhere. However, the extent to which the various inoculated Rhz strains, P application, and combined application of Rhz + P studies contribute to improving yield, performed on a comprehensive analysis approach, and profit farmers are yet to be understood. This study reviewed different experimental studies conducted on soybean ( (L.) Merr.), cowpea ( [L.] Walp), and groundnut ( [L.]) to which Rhz inoculants, P supplements, or Rhz + P combination were applied to improve the yield in Ghana. Multiple-step search combinations of published articles and multivariate analysis computing approaches were used to assess the effects of Rhz inoculation, P application, or both application of Rhz and P on yield variation. The random forest (RF) regression model was further employed to quantify the relative importance of various predictor variables on yield. The meta-analysis results showed that cowpea exhibited the highest (61.7%) and groundnut (19.8%) the lowest average yield change. The RF regression model revealed that the combined application of Rhz and P fertilizer (10.5%) and Rhz inoculation alone (7.8%) were the highest explanatory variables to predict yield variation in soybean. The Rhz + P combination, Rhz inoculation, and genotype wang-Kae explained 11.6, 10.02, and 8.04% of yield variability for cowpea, respectively. The yield in the inoculated plants increased by 1.48-, 1.26-, and 1.16-fold when compared to that in the non-inoculated cowpea plants following inoculation with BR 3299, KNUST 1002, and KNUST 1006 strains, respectively. KNUST 1006 strain exhibited the highest yield increase ratio (1.3-fold) in groundnut plants. Inoculants formulation with a viable concentration of 10 cells g and a minimum inoculum rate of 1.0 × 10 cells seed achieved the highest average yield change for soybean but not for cowpea and groundnut. The meta-analysis calls for prospective studies to investigate the minimum rate of bacterial cells required for optimum inoculation responses in cowpea and groundnut.
PubMed: 35812914
DOI: 10.3389/fpls.2022.877433 -
Clinical Interventions in Aging 2017The aim is to systematically assess the effectiveness and safety of Chinese herbal formula Erxian decoction (EXD) for treating osteoporosis. (Review)
Review
PURPOSE
The aim is to systematically assess the effectiveness and safety of Chinese herbal formula Erxian decoction (EXD) for treating osteoporosis.
MATERIALS AND METHODS
Six databases were searched from inception through September 17, 2016, without language restriction. All randomized controlled trials of EXD for osteoporosis were included. One or more outcome measures including fracture, change in bone mineral density (BMD), pain symptom improvement, bone biochemical markers, quality of life, adverse event or adverse drug reaction were evaluated. Study selection, data extraction, quality assessment, and data analyses were conducted according to Cochrane standards.
RESULTS
Eight trials including 644 patients investigated the effects of EXD in the treatment of osteoporosis. The methodological quality of the included trials was generally low. The meta-analysis from two trials showed favorable effects of EXD in improving BMD of lumbar spine (mean difference [MD]: 0.05 [0.03, 0.06]; =0%; <0.00001) and BMD of femoral great trochanter (MD: 0.06 [0.02, 0.10]; =59%; =0.005) compared with caltrate tablets. The other meta-analysis from two trials showed beneficial effects of EXD plus caltrate tablets and calcitriol in improving BMD of femoral neck (MD: 0.04 [0.00, 0.09]; =56%; =0.04), the level of calcium (MD: 0.20 [0.15, 0.24]; =0%; <0.00001), and phosphorus (MD: -0.28 [-0.39, -0.17]; =68%; <0.00001) compared with caltrate tablets and calcitriol alone. The adverse drug reactions of EXD were mainly slight gastrointestinal symptoms.
CONCLUSION
The study provides suggestive evidence of the superiority of EXD monotherapy or combination therapy over basic supplements for treating osteoporosis. However, the evidence remains weak. More rigorously designed and measured, randomized double-blind, placebo-controlled trials with larger sample size are needed to verify the current conclusions.
Topics: Biomarkers; Bone Density; Calcitriol; Drugs, Chinese Herbal; Humans; Lumbar Vertebrae; Meta-Analysis as Topic; Osteoporosis; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28115834
DOI: 10.2147/CIA.S117597 -
International Journal of Infectious... Nov 2022Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are recommended as first-line treatments for chronic hepatitis B (CHB). However, the safety of these two drugs... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are recommended as first-line treatments for chronic hepatitis B (CHB). However, the safety of these two drugs remains controversial. This study aimed to evaluate and compare renal function and bone mineral density in patients with CHB who took TDF or ETV.
METHODS
The electronic databases of the Cochrane Library, PubMed, and Embase were searched. The keywords were: "CHB", "tenofovir", and "entecavir". Heterogeneity and subgroups were analyzed.
RESULTS
A total of 16 studies met the inclusion criteria. There was no significant difference in serum creatinine levels between the TDF and the ETV group. There was a significant standardized mean difference (SMD) in the serum estimated glomerular filtration rate between months (12 months: SMD [95% confidence interval] = -0.07 [-0.12, -0.01]; 18-24 months: SMD [95% confidence interval] = -0.11 [-0.17, -0.05]), but no significant difference emerged in the long-term drug use for over 24 months. There was no significant difference in the incidence of osteopenia/osteoporosis (I = 41%, risk ratio [95% confidence interval] = 1.29 [0.93, 1.77], P-value = 0.13 >0.05).
CONCLUSION
Compared with the ETV group, a greater reduction in estimated glomerular filtration rate and serum phosphorus levels was observed in the TDF group. There was no significant difference in the incidence of osteopenia/osteoporosis between the two groups.
Topics: Humans; Tenofovir; Hepatitis B, Chronic; Bone Density; Antiviral Agents; Kidney; Bone Diseases, Metabolic; Osteoporosis; Treatment Outcome; Retrospective Studies
PubMed: 36122671
DOI: 10.1016/j.ijid.2022.09.021 -
Frontiers in Medicine 2023To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte...
Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials.
OBJECTIVE
To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte lavage solution (PEGL) to inform clinical decision making.
METHODS
PubMed, Embase, CBM, WanFang Data, CNKI, and VIP databases were searched for studies that used randomized controlled trials (RCTs) to compare the roles of NaPTab and PEGL in bowel preparation before colonoscopy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias in the included papers. A meta-analysis was performed using RevMan 5.3 software.
RESULTS
A total of 13 RCTs were eligible for inclusion, including 2,773 patients (1,378 and 1,395 cases in the NaPTab and PEGL groups, respectively). Meta-analysis revealed no significant difference in the cleansing quality of the NaPTab and PEGL groups [RR 1.02, 95% CI (0.96-1.08), = 0.46]. The incidence of nausea was lower in the NaPTab group than in the PEGL group [RR 0.67, 95% CI (0.58-0.76), < 0.00001]. Patients rated the taste of NaPTab higher than PEGL [RR 1.33, 95% CI (1.26-1.40), < 0.00001]. Willingness to repeat the treatment was also higher in the NaPTab group than in the PEGL group [RR 1.52, 95% CI (1.28-1.80), < 0.00001]. Both serum potassium and serum calcium decreased in both groups after the preparation; however, meta-analysis revealed that both minerals decreased more in the NaPTab group than in the PEGL group [MD = 0.38, 95% CI (0.13-0.62), = 0.006 for serum potassium and MD = 0.41, 95% CI (0.04-0.77), = 0.03 for serum calcium]. Meanwhile, serum phosphorus increased in both groups after the preparation; however, levels increased more in the NaPTab group than in the PEGL group [MD 4.51, (95% CI 2.9-6.11), < 0.00001].
CONCLUSIONS
While NaP tablets and PEGL were shown to have a similar cleaning effect before colonoscopy, NaP tablets had improved patient tolerance. However, NaP tablets had a strong effect on serum potassium, calcium, and phosphorus levels. For patients with low potassium, low calcium, and renal insufficiency, NaP tablets should be prescribed with caution. For those at high-risk for acute phosphate nephropathy, NaP tablets should be avoided. Given the low number and quality of included studies, these conclusions will require additional verification by large high-quality studies.
SYSTEMATIC REVIEW REGISTRATION
10.37766/inplasy2023.5.0013, identifier: NPLASY202350013.
PubMed: 37305114
DOI: 10.3389/fmed.2023.1088630 -
Frontiers in Plant Science 2023With the continuous changes in climate patterns due to global warming, drought has become an important limiting factor in the development of terrestrial ecosystems....
INTRODUCTION
With the continuous changes in climate patterns due to global warming, drought has become an important limiting factor in the development of terrestrial ecosystems. However, a comprehensive understanding of the impact of drought on soil microbial activity at a global scale is lacking.
METHODS
In this study, we aimed to examine the effects of drought on soil microbial biomass (carbon [MBC], nitrogen [MBN], and phosphorus [MBP]) and enzyme activity (β-1, 4-glucosidase [BG]; β-D-cellobiosidase [CBH]; β-1, 4-N-acetylglucosaminidase [NAG]; L-leucine aminopeptidase [LAP]; and acid phosphatase [AP]). Additionally, we conducted a meta-analysis to determine the degree to which these effects are regulated by vegetation type, drought intensity, drought duration, and mean annual temperature (MAT).
RESULT AND DISCUSSION
Our results showed that drought significantly decreased the MBC, MBN, and MBP and the activity levels of BG and AP by 22.7%, 21.2%, 21.6%, 26.8%, and 16.1%, respectively. In terms of vegetation type, drought mainly affected the MBC and MBN in croplands and grasslands. Furthermore, the response ratio of BG, CBH, NAG, and LAP were negatively correlated with drought intensity, whereas MBN and MBP and the activity levels of BG and CBH were negatively correlated with drought duration. Additionally, the response ratio of BG and NAG were negatively correlated with MAT. In conclusion, drought significantly reduced soil microbial biomass and enzyme activity on a global scale. Our results highlight the strong impact of drought on soil microbial biomass and carbon- and phosphorus-acquiring enzyme activity.
PubMed: 37692424
DOI: 10.3389/fpls.2023.1221288 -
Food and Chemical Toxicology : An... Apr 2022Micronutrients constitute an adjuvant treatment for respiratory viral infections. Since there is no effective antiviral therapy for COVID-19 yet, adjuvant intervention... (Review)
Review
Micronutrients constitute an adjuvant treatment for respiratory viral infections. Since there is no effective antiviral therapy for COVID-19 yet, adjuvant intervention for the survival of critically ill patients may be significant. Search of the PubMed, CINAHL and Cochrane databases was carried out to find human studies investigating the prognostic role of micronutrient status and the effects of micronutrient supplementation intervention in COVID-19 outcomes of adult patients. Patients with certain comorbidities (diabetes mellitus type 2, obesity, renal failure, liver dysfunction etc.) or pregnant women were excluded. 31 studies (27 observational studies and 4 clinical trials) spanning the years 2020-2021, pertaining to 8624 COVID-19 patients (mean age±SD, 61 ± 9 years) were included in this systematic review. Few studies provided direct evidence on the association of serum levels of vitamin D, calcium, zinc, magnesium, phosphorus and selenium to patients' survival or death. Vitamin D and calcium were the most studied micronutrients and those with a probable promising favorable impact on patients. This review highlights the importance of a balanced nutritional status for a favorable outcome in COVID-19. Micronutrients' deficiency on admission to hospital seems to be related to a high risk for ICU admission, intubation and even death. Nevertheless, evidence for intervention remains unclear.
PubMed: 35227861
DOI: 10.1016/j.fct.2022.112901