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International Urology and Nephrology Jul 2018Patients with psoriasis may have a higher risk of developing chronic kidney (CKD) and end-stage renal disease (ESRD) compared with general population. This systematic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Patients with psoriasis may have a higher risk of developing chronic kidney (CKD) and end-stage renal disease (ESRD) compared with general population. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available evidence.
METHODS
A systematic review was performed using MEDLINE and EMBASE database from inception to January 2018 to identify all cohort studies that compared the risk of incident CKD and/or ESRD in patients with psoriasis versus individuals without psoriasis. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse variance method.
RESULTS
A total of four retrospective cohort studies with 199,808 patients with psoriasis were included. The risk of incident CKD and ESRD was significantly increased among patients with psoriasis with the pooled risk ratio of 1.34 (95% CI, 1.14-1.57) and 1.29 (95% CI, 1.05-1.60), respectively.
CONCLUSION
A significantly increased risk of incident CKD and ESRD among patients with psoriasis compared with individuals without psoriasis was demonstrated in this study.
Topics: Adult; Age Distribution; Comorbidity; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Prognosis; Psoriasis; Renal Insufficiency, Chronic; Retrospective Studies; Risk Assessment; Sex Distribution; Survival Rate; Thailand
PubMed: 29644523
DOI: 10.1007/s11255-018-1868-z -
Medicine Nov 2016Renal insufficiency is a common and severe complication of patients with multiple myeloma. The aim of this study was to evaluate bortezomib-based treatment for multiple... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Renal insufficiency is a common and severe complication of patients with multiple myeloma. The aim of this study was to evaluate bortezomib-based treatment for multiple myeloma patients with renal insufficiency.
METHODS
The Cochrane Library, Embase, PubMed, ISI, China National Knowledge Infrastructure, Chinese Biomedical Literature Service System, Chongqing VIP Database, and Wan Fang Data were systematically searched to identify observational studies from January 1, 2001, to December 31, 2015. Myeloma response rate and renal remission rate were pooled by using risk ratio and 95% confidence interval (CI). The Cochran Q and I statistics were used to assess heterogeneity. Sensitivity analysis was performed to test the feasibility of pooled results. Publication bias was conducted when included studies were ≥9. Furthermore, grades of evidence were performed to evaluate study quality.
RESULTS
Eleven retrospective cohort studies were included in the final analysis. The number of available studies and risk ratios (95% CI) were, respectively, 10 and 1.48 (95% CI: 1.28-1.71) for myeloma overall response, 6 and 3.69 (95% CI: 2.22-6.13) for myeloma complete response, 9 and 1.47 (95% CI: 1.28-1.69) for renal overall remission, and 8 and 1.49 (95% CI: 1.26-1.75) for renal complete remission. No significant publication bias was observed and sensitivity analysis confirmed the stability of results. The overall qualities of evidence were high for myeloma complete response and medium for the other 3 outcomes based on the Grading of Recommendations, Assessment, Development and Evaluation system.
CONCLUSION
Current evidence indicated that bortezomib-based treatment could improve myeloma overall response (especially myeloma complete response) and renal overall remission (including renal complete remission).
Topics: Antineoplastic Agents; Bortezomib; Humans; Multiple Myeloma; Observational Studies as Topic; Remission Induction; Renal Insufficiency
PubMed: 27861343
DOI: 10.1097/MD.0000000000005202 -
BMC Nephrology Apr 2015Hyperuricemia may contribute to renal injury. We do not know whether use of treatments that lower urate reduce the progression of chronic kidney disease (CKD) and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hyperuricemia may contribute to renal injury. We do not know whether use of treatments that lower urate reduce the progression of chronic kidney disease (CKD) and cardiovascular disease. We performed a systematic review and meta-analysis of randomized controlled trials to assess the benefits and risks of treatments that lower urate in patients with stages 3-5 CKD.
METHODS
We searched MEDLINE, EMBASE, CENTRAL, Web of Science and trial registers for randomized controlled trials (RCTs) without language restriction. Two authors independently screened articles, assessed risk of bias and extracted data. Data obtained included serum uric acid, serum creatinine or other estimates of glomerular filtration rate, incidence of end-stage renal disease (ESRD), systolic and diastolic blood pressure, proteinuria, cardiovascular disease and adverse events.
RESULTS
From the 5497 citations screened, 19 RCTs enrolling 992 participants met our inclusion criteria. Given significant heterogeneity in duration of follow-up and study comparators, only trials greater than 3 months comparing allopurinol and inactive control were meta-analyzed using random effects models. Pooled estimate for eGFR was in favour of allopurinol with a mean difference (MD) of 3.2 ml/min/1.73 m(2), 95% CI 0.16-6.2 ml/min/1.73 m(2), p = 0.039 and this was consistent with results for serum creatinine. Statistically significant reductions in serum uric acid, systolic and diastolic blood pressure were found, favouring allopurinol. There were insufficient data on adverse events, incidence of ESRD and cardiovascular disease for analysis.
CONCLUSIONS
Adequately powered RCTs are needed to establish whether treatments that lower urate have beneficial renal and cardiovascular effects.
Topics: Cardiovascular Diseases; Creatinine; Disease Progression; Glomerular Filtration Rate; Gout Suppressants; Humans; Hyperuricemia; Kidney Failure, Chronic; Renal Insufficiency, Chronic; Treatment Outcome; Uric Acid; Uricosuric Agents
PubMed: 25928556
DOI: 10.1186/s12882-015-0047-z -
Endocrine Jan 2017Diabetes mellitus is a strong risk factor for chronic kidney disease and end-stage renal disease. Whether sex differences in chronic kidney disease and end-stage renal... (Comparative Study)
Comparative Study Meta-Analysis Review
Diabetes mellitus is a strong risk factor for chronic kidney disease and end-stage renal disease. Whether sex differences in chronic kidney disease and end-stage renal disease incidence exist among diabetic patients remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative effect of diabetes on chronic kidney disease and end-stage renal disease risk in women compared with men. We systematically searched Embase, PubMed, and the Cochrane Library for both cohort and case-control studies until October 2015. Studies were selected if they reported a sex-specific relationship between diabetes mellitus and chronic kidney disease or end-stage renal disease. We generated pooled estimates across studies using random-effects meta-analysis after log transformation with inverse variance weighting. Ten studies with data from more than 5 million participants were included. The pooled adjusted risk ratio of chronic kidney disease associated with diabetes mellitus was 3.34 (95 % CI 2.27, 4.93) in women and 2.84 (95 % CI 1.73, 4.68) in men. The data showed no difference in diabetes-related chronic kidney disease risk between the sexes (pooled adjusted women-to-men relative risk ratio was 1.14 [95 % CI 0.97, 1.34]) except for end-stage renal disease-the pooled adjusted women-to men relative risk ratio was 1.38 (95 % CI 1.22, 1.55; p = 0.114, I² = 38.1 %). The study found no evidence of a sex difference in the association between diabetes mellitus and chronic kidney disease. However, the excess risk for end-stage renal disease was higher in women with diabetes than in men with the same condition, from which we assume that the female gender could accelerate the disease progression. Further studies are needed to support this notion and elucidate the underlying mechanisms.
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Disease Progression; Evidence-Based Medicine; Female; Global Health; Health Transition; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Observational Studies as Topic; Prevalence; Renal Insufficiency, Chronic; Risk Factors; Sex Factors
PubMed: 27477292
DOI: 10.1007/s12020-016-1014-6 -
Transplantation Reviews (Orlando, Fla.) Jan 2019The prevalence of atrial fibrillation (AF) in patients undergoing renal (RT) or liver transplantation (LT) has increased during the last decades. Yet, there is still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The prevalence of atrial fibrillation (AF) in patients undergoing renal (RT) or liver transplantation (LT) has increased during the last decades. Yet, there is still uncertainty on the association between AF and patient and graft survival.
METHODS
Multiple electronic databases were searched using various combinations of keywords and MeSH terms pertinent to the exposure (AF), and outcomes (graft and patient survival). Randomized or quasi-randomized controlled studies, cohort and case-control studies on adults with documented AF undergoing RT or LT were included. The quality of studies was assessed using the Newcastle-Ottawa Assessment Scale. When appropriate, data on the primary and secondary outcomes were pooled in a meta-analysis using the random-effect model. The Odds ratio was used for patients undergoing LT and the hazard ratio was used for patients who underwent renal transplantation.
RESULTS
A total of 50,362 publications were identified. Six studies, with a total of 136,331 patients, satisfied the inclusion criteria. LT was performed on 2861 patients and RT was performed on 133,470 recipients. Overall, AF affected 6652 (4.8%) transplant recipients. Among them, 153 received a LT and 6499 underwent RT. The OR for mortality after LT was 2.375 (95% CI; 1.532-3.682) (P = 0.000) in AF(+) recipients and the HR was 1.859 (95% CI; 1.031-3.354) (P = 0.039) after RT. The OR for graft loss in AF(+) after LT r was 1.088 (95% CI; 0.311-3.804) (P = 0.894) and the HR for graft loss was 1.632 (95% CI; 1.200-2.218) (P = 0.002) after RT.
CONCLUSIONS
To the best of our knowledge, this is the first systematic review and meta-analysis to explore the association between AF and patient and graft survival after RT or LT. Our findings suggest that the presence of AF is associated with inferior patient survival. For renal transplant recipients, AF is also associated with inferior graft survival.
Topics: Atrial Fibrillation; End Stage Liver Disease; Graft Survival; Humans; Kidney Transplantation; Liver Transplantation; Renal Insufficiency, Chronic
PubMed: 30139706
DOI: 10.1016/j.trre.2018.07.003 -
Archives of Gerontology and Geriatrics 2017Frailty is associated with increased vulnerability to poor health. There is growing interest in understanding the association between frailty and chronic kidney disease... (Review)
Review
OBJECTIVE
Frailty is associated with increased vulnerability to poor health. There is growing interest in understanding the association between frailty and chronic kidney disease (CKD). This systematic review explored how frailty is measured in patients with CKD and the association between frailty and adverse outcomes across different stages of renal impairment.
STUDY DESIGN
Systematic analysis of peer reviewed articles.
DATA SOURCES
Pubmed, Medline, Web of Science and Cochrane were used to identify the articles.
DATA SYNTHESIS
Articles published before the 17th of September 2016, that measured frailty in patients with CKD was eligible for the systematic review. Two independent researchers assessed the eligibility of the articles. Quality of the articles was assessed using the Epidemiological Appraisal Instrument.
RESULTS
The literature search yielded 540 articles, of which 32 met the study criteria and were included in the review (n=36,076, age range: 50-83 years). Twenty-three (72%) studies used or adapted the Fried phenotype to measure frailty. The prevalence of frailty ranged from 7% in community-dwellers (CKD Stages 1-4) to 73% in a cohort of patients on haemodialysis. The incidence of frailty increased with reduced glomerular filtration rate. Frailty was associated with an increased risk of mortality and hospitalization.
CONCLUSION
Frailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes. There are differences in the methods used to assess frailty and this hinders comparisons between studies.
Topics: Aged; Aged, 80 and over; Frail Elderly; Geriatric Assessment; Hospitalization; Humans; Kidney Transplantation; Middle Aged; Renal Dialysis; Renal Insufficiency, Chronic; Severity of Illness Index
PubMed: 27810661
DOI: 10.1016/j.archger.2016.10.007 -
Sleep & Breathing = Schlaf & Atmung Mar 2021Obstructive sleep apnea syndrome (OSAS) is associated with a variety of systemic diseases. Among patients with chronic kidney diseases (CKD), the prevalence of OSAS is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnea syndrome (OSAS) is associated with a variety of systemic diseases. Among patients with chronic kidney diseases (CKD), the prevalence of OSAS is high. OSAS can induce progression of CKD. However, whether or not OSAS can cause renal damage in healthy people is not clear. Thus, the purpose of this meta-analysis was to elucidate whether or not there was an association between OSAS and early renal damage.
METHODS
PubMed, Embase Database, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Database, Chinese Scientific Journals Database, and Wanfang Database were searched systematically. The relative risk (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used to evaluate the relationship between OSAS and early renal damage. Funnel plot and Egger's test were used to evaluate publication bias, and trial sequential analysis (TSA) was employed to verify the sufficiency of the research conclusions.
RESULTS
A total of 18 studies were analyzed comprising 4,567 participants. Compared with the healthy control group, levels of cystatin C (MD = 0.530, 95% CI 0.423, 0.637, P < 0.01) and proteinuria in patients with OSAS were significantly increased, while the levels of estimated glomerular filtration rate (eGFR) (MD = - 0.194, 95% CI - 0.268, - 0.121, P < 0.01) were significantly decreased. Furthermore, patients with OSAS also had an increased risk of CKD. Subgroup analysis showed that compared with patients without OSAS, the level of serum cystatin C in patients with OSAS was significantly increased independent of hypertension and diabetes, and the eGFR was significantly decreased in patients with moderate to severe OSAS and comorbid hypertension and/or diabetes.
CONCLUSION
In this meta-analysis, OSAS was associated with a higher risk of early renal damage. Patients with OSAS and comorbid hypertension and/or diabetes appear to suffer from severe renal damage.
Topics: Humans; Renal Insufficiency, Chronic; Sleep Apnea, Obstructive
PubMed: 32440991
DOI: 10.1007/s11325-020-02090-5 -
Journal of the American Society of... Jan 2022Benefits of phosphate-lowering interventions on clinical outcomes in patients with CKD are unclear; systematic reviews have predominantly involved patients on dialysis.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Benefits of phosphate-lowering interventions on clinical outcomes in patients with CKD are unclear; systematic reviews have predominantly involved patients on dialysis. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of noncalcium-based phosphate-lowering treatment in nondialysis CKD.
METHODS
We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared with placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow-up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence.
RESULTS
In total, 20 trials involving 2498 participants (median sample size 120, median follow-up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, noncalcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37; 95% CI, -0.58 to -0.15 mg/dl, low certainty evidence) and urinary phosphate excretion (eight trials, SMD -0.61; 95% CI, -0.90 to -0.31, low certainty evidence), but resulted in increased constipation (nine trials, log odds ratio [OR] 0.93; 95% CI, 0.02 to 1.83, low certainty evidence) and greater vascular calcification score (three trials, SMD, 0.47; 95% CI, 0.17 to 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR, 0.51; 95% CI, -0.51 to 1.17) and death were scant.
CONCLUSIONS
Noncalcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.
Topics: Chelating Agents; Ferric Compounds; Humans; Hyperphosphatemia; Lanthanum; Phosphates; Renal Insufficiency, Chronic; Sevelamer
PubMed: 34645696
DOI: 10.1681/ASN.2021040554 -
Pharmacological Research May 2016Chronic kidney disease (CKD) represents an important health problem worldwide and the search for new therapeutic approaches for retarding CKD progression is a timely... (Meta-Analysis)
Meta-Analysis Review
Chronic kidney disease (CKD) represents an important health problem worldwide and the search for new therapeutic approaches for retarding CKD progression is a timely issue. Recent evidence suggest that the anti-inflammatory and hemorrheologic drug Pentoxifylline (PTX), may produce favorable effects on kidney function. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to ascertain whether PTX derivatives, alone or in combination to other treatments, may be useful in slowing down disease progression in patients with diabetic or non-diabetic CKD. We found 26 studies (1518 subjects) matching our search criteria. Information on the effects of PTX on hard renal outcomes (doubling of serum creatinine or need for chronic dialysis) were lacking in all the reviewed trials. Conversely, PTX was effective in reducing proteinuria compared to control, a benefit that was more evident in patients with type-1 diabetes mellitus, higher proteinuria at baseline and early renal impairment. An improvement in renal function (eGFR/creatinine clearance) was observed particularly in patients with more advanced CKD stage and in studies with longer follow-up. Conversely, cumulative analyses did not reveal any evident reduction in urinary albumin excretion, even in diabetic patients. The use of PTX was relatively safe as most trials recorded only minor gastrointestinal adverse effects. Although these findings point at some reno-protective effects of PTX, there is no conclusive evidence proving the usefulness of this agent for improving renal outcomes in subjects with chronic kidney disease of various etiology. Future trials adequately powered and designed on hard clinical end-points are needed.
Topics: Humans; Kidney; Pentoxifylline; Proteinuria; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic
PubMed: 26995301
DOI: 10.1016/j.phrs.2016.03.001 -
International Urology and Nephrology Dec 2023In recent years, increasing evidence has shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) drugs have potential renoprotective effects in patients with... (Meta-Analysis)
Meta-Analysis
PURPOSE
In recent years, increasing evidence has shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) drugs have potential renoprotective effects in patients with diabetes mellitus (DM). However, the renal protective effect of SGLT2i in non-diabetic nephropathy patients has not been extensively demonstrated. In this systematic review and meta-analysis, we aimed to evaluate the renal protective effect and safety of SGLT2i in non-diabetic nephropathy patients.
METHODS
we searched for relevant clinically randomised controlled trials and analyzed the effects of SGLT2i on estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (UACR), and systolic blood pressure (SBP) and the incidence of adverse events in patients with non-diabetic nephropathy.
RESULTS
We collated and analysed clinical data from six groups of patients with nondiabetic nephropathy. It was found that the SGLT2i significantly delayed the decline in eGFR [MD = 1.35 ml/min/1.73 m, 95% CI 0.84, 1.86), P < 0.0001]. Furthermore, the SGLT2i significantly reduced UACR [MD = - 24.47% l, 95% CI (- 38.9, -10.04), P = 0.0009], and showed a greater decrease in SBP [MD = - 4.13 mmHg, 95% CI (- 7.49, - 0.77), P = 0.02]. There was no significant difference in the incidence of adverse reactions between dapagliflozin/empagliflozin and the control group [OR = 1.14, 95% CI (0.88, 1.47), P = 0.33].
CONCLUSION
This study shows that SGLT2i help to delay the progression of non-diabetic kidney disease. Therefore, SGLT2i may contribute to the general treatment of nondiabetic nephropathy.
Topics: Humans; Sodium-Glucose Transporter 2 Inhibitors; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Renal Insufficiency, Chronic; Kidney
PubMed: 37046125
DOI: 10.1007/s11255-023-03586-1