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The Cochrane Database of Systematic... Jul 2019Fluid therapy is one of the main interventions provided for critically ill patients, although there is no general consensus regarding the type of solution. Among...
BACKGROUND
Fluid therapy is one of the main interventions provided for critically ill patients, although there is no general consensus regarding the type of solution. Among crystalloid solutions, 0.9% saline is the most commonly administered. Buffered solutions may offer some theoretical advantages (less metabolic acidosis, less electrolyte disturbance), but the clinical relevance of these remains unknown.
OBJECTIVES
To assess the effects of buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children.
SEARCH METHODS
We searched the following databases to July 2018: CENTRAL, MEDLINE, Embase, CINAHL, and four trials registers. We checked references, conducted backward and forward citation searching of relevant articles, and contacted study authors to identify additional studies. We imposed no language restrictions.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) with parallel or cross-over design examining buffered solutions versus intravenous 0.9% saline in a critical care setting (resuscitation or maintenance). We included studies on participants with critical illness (including trauma and burns) or undergoing emergency surgery during critical illness who required intravenous fluid therapy. We included studies of adults and children. We included studies with more than two arms if they fulfilled all of our inclusion criteria. We excluded studies performed in persons undergoing elective surgery and studies with multiple interventions in the same arm.
DATA COLLECTION AND ANALYSIS
We used Cochrane's standard methodological procedures. We assessed our intervention effects using random-effects models, but when one or two trials contributed to 75% of randomized participants, we used fixed-effect models. We reported outcomes with 95% confidence intervals (CIs).
MAIN RESULTS
We included 21 RCTs (20,213 participants) and identified three ongoing studies. Three RCTs contributed 19,054 participants (94.2%). Four RCTs (402 participants) were conducted among children with severe dehydration and dengue shock syndrome. Fourteen trials reported results on mortality, and nine reported on acute renal injury. Sixteen included trials were conducted in adults, four in the paediatric population, and one trial limited neither minimum or maximum age as an inclusion criterion. Eight studies involving 19,218 participants were rated as high methodological quality (trials with overall low risk of bias according to the domains: allocation concealment, blinding of participants/assessors, incomplete outcome data, and selective reporting), and in the remaining trials, some form of bias was introduced or could not be ruled out.We found no evidence of an effect of buffered solutions on in-hospital mortality (odds ratio (OR) 0.91, 95% CI 0.83 to 1.01; 19,664 participants; 14 studies; high-certainty evidence). Based on a mortality rate of 119 per 1000, buffered solutions could reduce mortality by 21 per 1000 or could increase mortality by 1 per 1000. Similarly, we found no evidence of an effect of buffered solutions on acute renal injury (OR 0.92, 95% CI 0.84 to 1.00; 18,701 participants; 9 studies; low-certainty evidence). Based on a rate of 121 per 1000, buffered solutions could reduce the rate of acute renal injury by 19 per 1000, or result in no difference in the rate of acute renal injury. Buffered solutions did not show an effect on organ system dysfunction (OR 0.80, 95% CI 0.40 to 1.61; 266 participants; 5 studies; very low-certainty evidence). Evidence on the effects of buffered solutions on electrolyte disturbances varied: potassium (mean difference (MD) 0.09, 95% CI -0.10 to 0.27; 158 participants; 4 studies; very low-certainty evidence); chloride (MD -3.02, 95% CI -5.24 to -0.80; 351 participants; 7 studies; very low-certainty evidence); pH (MD 0.04, 95% CI 0.02 to 0.06; 200 participants; 3 studies; very low-certainty evidence); and bicarbonate (MD 2.26, 95% CI 1.25 to 3.27; 344 participants; 6 studies; very low-certainty evidence).
AUTHORS' CONCLUSIONS
We found no effect of buffered solutions on preventing in-hospital mortality compared to 0.9% saline solutions in critically ill patients. The certainty of evidence for this finding was high, indicating that further research would detect little or no difference in mortality. The effects of buffered solutions and 0.9% saline solutions on preventing acute kidney injury were similar in this setting. The certainty of evidence for this finding was low, and further research could change this conclusion. Patients treated with buffered solutions showed lower chloride levels, higher levels of bicarbonate, and higher pH. The certainty of evidence for these findings was very low. Future research should further examine patient-centred outcomes such as quality of life. The three ongoing studies once published and assessed may alter the conclusions of the review.
Topics: Adult; Child; Critical Care; Critical Illness; Fluid Therapy; Hospital Mortality; Humans; Randomized Controlled Trials as Topic; Rehydration Solutions; Saline Solution
PubMed: 31334842
DOI: 10.1002/14651858.CD012247.pub2 -
Journal of Cardiovascular Medicine... Jun 2019Loop diuretics have become a mainstay of chronic heart failure management. Furosemide and torsemide are the two most common loop diuretics; nevertheless, there is... (Meta-Analysis)
Meta-Analysis
AIMS
Loop diuretics have become a mainstay of chronic heart failure management. Furosemide and torsemide are the two most common loop diuretics; nevertheless, there is inconsistent evidence regarding the optimal choice of loop diuretic with respect to clinical outcomes.
METHODS
Medline and Cochrane Databases were systemically reviewed for randomized and observational studies comparing patients with chronic heart failure on oral torsemide versus oral furosemide and their association with intermediate-term outcomes (5-12 months) through May 2018. Odds ratios with corresponding 95% confidence intervals (CIs) were used for outcomes. A random effect model was used to account for heterogeneity among studies. Heterogeneity was assessed with the Higgins I-square statistic.
RESULTS
A total of 8127 patients were included in the analysis from a total of 14 studies (10 randomized, four observational); 5729 patients were prescribed furosemide and 2398 were given torsemide. There was no significant difference in intermediate-term mortality among heart failure patients on furosemide compared with torsemide [odds ratio (OR) 1.01, CI 0.64-1.59, I = 65.8%]; however, furosemide was associated with an increased risk of heart failure readmissions (OR 2.16, CI 1.28-2.64, I = 0.0%). Heart failure patients taking torsemide were more likely to have an improvement in New York Heart Association class compared with those on furosemide (OR 0.73, CI 0.58-0.93, I = 19.6%).
CONCLUSION
Torsemide is associated with a reduction in intermediate-term heart failure readmissions and improvement in New York Heart Association class compared with furosemide but is not associated with a reduced mortality risk. Additional randomized trials are needed to examine the impact of loop diuretics on clinical outcomes in patients with heart failure.
Topics: Furosemide; Heart Failure; Humans; Observational Studies as Topic; Patient Readmission; Randomized Controlled Trials as Topic; Recovery of Function; Sodium Potassium Chloride Symporter Inhibitors; Time Factors; Torsemide; Treatment Outcome
PubMed: 30950982
DOI: 10.2459/JCM.0000000000000794 -
Heart Failure Reviews Jul 2019The majority of patients with chronic heart failure (HF) receive long-term treatment with loop diuretics. The comparative effectiveness of different loop diuretics is... (Meta-Analysis)
Meta-Analysis
The majority of patients with chronic heart failure (HF) receive long-term treatment with loop diuretics. The comparative effectiveness of different loop diuretics is unknown. We searched PubMed, clinicaltrials.gov , the Cochrane Central Register of Controlled Trials and the European Union Clinical Trials Register for randomised clinical trials exploring the efficacy of the loop diuretics azosemide, bumetanide, furosemide or torasemide in patients with HF. Comparators included placebo, standard medical care or any other active treatment. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, HF-related hospitalisation and any combined endpoint thereof. Hypokalaemia and acute renal failure were defined as additional safety endpoints. Evidence was synthesised using network meta-analysis (NMA). Thirty-four trials reporting on 2647 patients were included. The overall quality of evidence was rated as moderate. NMA demonstrated no significant differences between loop diuretics with respect to all-cause mortality, cardiovascular mortality or hypokalaemia. In contrast, torasemide ranked best in terms of HF hospitalisation, and there was a trend towards benefits with torasemide with regard to occurrence of acute renal failure. Sensitivity analyses excluding trials with a follow-up < 6 months, trials with a cross-over design and those including < 25 patients confirmed the main results. We found no significant superiority of either loop diuretic with respect to mortality and safety endpoints. However, clinicians may prefer torasemide, as it was associated with fewer HF-related hospitalisations.
Topics: Bias; Chronic Disease; Heart Failure, Systolic; Humans; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Sodium Potassium Chloride Symporter Inhibitors; Treatment Outcome
PubMed: 30874955
DOI: 10.1007/s10741-019-09771-8 -
The Cochrane Database of Systematic... Nov 2018Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is...
BACKGROUND
Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is still prevalent in large parts of the world.
OBJECTIVES
To assess the effects of iodine supplementation overall, and of different forms and dosages of iodine supplementation separately, in the prevention of iodine deficiency disorders in children.
SEARCH METHODS
The Cochrane Library, MEDLINE, EMBASE and reference lists, databases of ongoing trials and the Internet were searched.
SELECTION CRITERIA
We included randomised controlled trials and prospective controlled trials not using randomisation of iodine supplementation in children living in areas of iodine deficiency.
DATA COLLECTION AND ANALYSIS
Two reviewers did the initial data selection and quality assessment of trials independently. As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format.
MAIN RESULTS
Twenty-six prospective controlled trials were related to our question, assessing a total of 29613 children. Twenty of them were classified as being of low quality, six of moderate quality. Most studies used iodised oil as a supplement, but other supplements were also used. The intervention groups were compared to a non-supplemented control group, different doses or different forms of iodine supplementation.There was a clear tendency towards goitre reduction with iodine supplementation; this was significant in several studies. Significant differences in physical development were not seen, except in one study. Results for differences in cognitive and psychomotor measures were mixed, with only few studies showing a positive intervention effect. One study suggested that infant mortality was lowered after iodine supplementation.Most studies showed a significant increase in urinary iodine excretion and levels recommended by the WHO were reached in most cases after supplementation. Thyroid-stimulating hormone (TSH) levels were significantly reduced in one study. In 1.8% of the children investigated, adverse effects were found, most of them were minor and transient.
AUTHORS' CONCLUSIONS
Despite most of the included studies being of low quality, the results suggest that iodine supplementation, especially iodised oil, is an effective means of decreasing goitre rates and improving iodine status in children. Indications of positive effects on physical and mental development and mortality were seen, although results were not always significant. Adverse effects were generally minor and transient. Insufficient evidence was available on non-oil supplements. High quality controlled studies investigating relevant long term outcome measures are needed to address the question of the best form of iodine supplementation in different population groups and settings.
Topics: Child; Congenital Hypothyroidism; Controlled Clinical Trials as Topic; Dietary Supplements; Goiter; Humans; Iodates; Iodine; Iodized Oil; Myxedema; Potassium Compounds; Potassium Iodide; Sodium Chloride, Dietary
PubMed: 30489630
DOI: 10.1002/14651858.CD003819.pub3 -
Clinical Nutrition (Edinburgh, Scotland) Oct 2019Dietary salts sodium (Na), potassium (K), magnesium (Mg2), and calcium (Ca2) are important in metabolic diseases. Yet, we do not have sufficient understanding on the...
BACKGROUND
Dietary salts sodium (Na), potassium (K), magnesium (Mg2), and calcium (Ca2) are important in metabolic diseases. Yet, we do not have sufficient understanding on the salts global molecular network in these diseases. In this systematic review we have pooled information to identify the general effect of salts on obesity, insulin resistance and hypertension.
AIMS
To assess the roles of salts in metabolic disorders by focusing on their individual effect and the network effect among these salts.
METHODS
We searched articles in PubMed, EMBASE and Google Scholar. We selected original laboratory research, systematic reviews, clinical trials, observational studies and epidemiological data that focused on dietary salts and followed the preferred reporting items for systematic review in designing the present systematic review.
RESULTS
From the initial search of 2898 studies we selected a total of 199 articles that met our inclusion criteria and data extraction. Alterations in metabolic pathways associated with the sensitivity of sodium, potassium, magnesium and calcium may lead to obesity, hypertension, and insulin resistance. We found that the results of most laboratory research, animal studies and clinical trials are coherent but some research outcome are either inconsistent or inconclusive.
CONCLUSION
Important of salts in metabolic disorder is evident. In order to assess the effects of dietary salts in metablic diseases, environmental factors, dietary habits, physical activity, and the microbiome, should be considered in any study. Although interest in this area of research continues to grow, the challenge is to integrate the action of these salts in metabolic syndrom.
Topics: Animals; Calcium, Dietary; Energy Metabolism; Humans; Insulin; Magnesium; Metabolic Syndrome; Potassium; Sodium Chloride, Dietary
PubMed: 30446179
DOI: 10.1016/j.clnu.2018.10.021 -
Journal of Clinical Hypertension... Oct 2018Left ventricular hypertrophy develops in 36%-41% of hypertensive patients and independently predicts cardiovascular events and total mortality. Moreover, drug-induced... (Comparative Study)
Comparative Study Meta-Analysis
Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium-sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta-analysis.
Left ventricular hypertrophy develops in 36%-41% of hypertensive patients and independently predicts cardiovascular events and total mortality. Moreover, drug-induced reduction in left ventricular mass (LVM) correlates with improved prognosis. The optimal thiazide-type diuretic for reducing LVM is unknown. Evidence regarding potency, cardiovascular events, sodium, and potassium suggested the hypothesis that "CHIP" diuretics (CHlorthalidone, Indapamide, and Potassium-sparing diuretic/hydrochlorothiazide [PSD/HCTZ]) would reduce LVM more than HCTZ. Systematic searches of five databases were conducted. Among the 38 randomized trials, a 1% reduction in systolic blood pressure (SBP) predicted a 1% reduction in LVM, P = 0.00001. CHIP-HCTZ differences in reducing LVM differed across trials (ie, heterogeneity), making interpretation uncertain. However, among the 28 double-blind trials, heterogeneity was undetectable, and HCTZ reduced LVM (percent reduction [95% CI]) by -7.3 (-10.4, -4.2), P < 0.0001. CHIP diuretics surpassed HCTZ in reducing LVM: chlorthalidone -8.2 (-14.7, -1.6), P = 0.015; indapamide -7.5 (-12.7, -2.3), P = 0.005; and all CHIP diuretics combined -7.7 (-12.2, -3.1), P < 0.001. The comparison of PSD/HCTZ with HCTZ had low statistical power but favored PSD/HCTZ: -6.0 (-14.1, +2.1), P = 0.149. Thus, compared to HCTZ, CHIP diuretics had twice the effect on LVM. CHIP diuretics did not surpass HCTZ in reducing systolic or diastolic blood pressure: -0.3 (-5.0, +4.3) and -1.6 (-5.6, +2.4), respectively. The strength of evidence that CHIP diuretics surpass HCTZ for reducing LVM was high (GRADE criteria). In conclusion, these novel results have demonstrated that CHIP diuretics reduce LVM 2-fold more than HCTZ among hypertensive patients. Although generally related to LVM, blood pressure fails to explain the superiority of CHIP diuretics for reducing LVM.
Topics: Antihypertensive Agents; Blood Pressure; Chlorthalidone; Diuretics, Potassium Sparing; Drug Therapy, Combination; Female; Humans; Hydrochlorothiazide; Hypertension; Hypertrophy, Left Ventricular; Indapamide; Male; Middle Aged; Randomized Controlled Trials as Topic; Sodium Chloride Symporter Inhibitors; Thiazides
PubMed: 30251403
DOI: 10.1111/jch.13386 -
Heart Failure Reviews Jan 2019Diuretic therapy is important in critically ill patients because fluid overload impairs organ function and increases mortality. Compared to intermittent administration,... (Meta-Analysis)
Meta-Analysis
Diuretic therapy is important in critically ill patients because fluid overload impairs organ function and increases mortality. Compared to intermittent administration, continuous infusion of loop diuretics is theoretically superior in terms of diuresis and electrolyte balance. However, the available evidence is susceptible to carryover diuretic effects and resistance in earlier crossover trials. Consequently, we conducted a systematic review and meta-analysis of parallel-group randomized controlled trials to compare these two strategies in adults with acute decompensated heart failure. We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from their inceptions to May 26, 2018. We pooled the data using a random effects model. Our primary outcomes were all-cause mortality, length of hospital stay, and body weight reduction. We analyzed 12 parallel-group randomized controlled trials involving 923 patients. Compared with intermittent administration, continuous infusion of furosemide was not associated with an improvement in all-cause mortality (risk ratio 1.19; 95% confidence interval [CI], 0.65 to 2.16), length of hospital stay (weighted mean difference [WMD] - 0.88 days; 95% CI, - 2.76 to 1.01), or 24-h urine output (WMD 489.17 mL; 95% CI, - 183.18 to 1161.51), but was significantly associated with a greater body weight reduction (WMD 0.63 kg; 95% CI, 0.23 to 1.02). No differences in hypokalemia, hyponatremia, increased serum creatinine level, and hypotension were noted. Continuous infusion of furosemide, compared to intermittent administration, is associated with a greater body weight reduction and potential increase in 24-h urine output. The limited available evidence suggests no difference in adverse events between both strategies. Trial registration: PROSPERO (CRD42017083878).
Topics: Acute Disease; Aged; Aged, 80 and over; Female; Furosemide; Heart Failure; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Sodium Potassium Chloride Symporter Inhibitors; Treatment Outcome; Weight Loss
PubMed: 30054781
DOI: 10.1007/s10741-018-9727-7 -
The Cochrane Database of Systematic... Jul 2018Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are among the commonest reasons for patients to present to primary care with ear trouble.Wax is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems. When this mechanism fails, wax is retained in the canal and may become impacted; interventions to encourage its removal may then be needed. Application of ear drops is one of these methods. Liquids used to remove and soften wax are of several kinds: oil-based compounds (e.g. olive or almond oil); water-based compounds (e.g. sodium bicarbonate or water itself); a combination of the above or non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol.
OBJECTIVES
To assess the effects of ear drops (or sprays) to remove or aid the removal of ear wax in adults and children.
SEARCH METHODS
We searched the Cochrane ENT Trials Register; Cochrane Register of Studies; PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2018.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in which a 'cerumenolytic' was compared with no treatment, water or saline, an alternative liquid treatment (oil or almond oil) or another 'cerumenolytic' in adults or children with obstructing or impacted ear wax.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. The primary outcomes were 1) the proportion of patients (or ears) with complete clearance of ear wax and 2) adverse effects (discomfort, irritation or pain). Secondary outcomes were: extent of wax clearance; proportion of people (or ears) with relief of symptoms due to wax; proportion of people (or ears) requiring further intervention to remove wax; success of mechanical removal of residual wax following treatment; any other adverse effects recorded and cost. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included 10 studies, with 623 participants (900 ears). Interventions included: oil-based treatments (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol), water-based treatments (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate), other active comparators (e.g. saline or water alone) and no treatment. Nine of the studies were more than 15 years old.The overall risk of bias across the 10 included studies was low or unclear.
PRIMARY OUTCOME
proportion of patients (or ears) with complete clearance of ear waxSix studies (360 participants; 491 ears) contributed quantitative data and were included in our meta-analyses.Active treatment versus no treatmentOnly one study addressed this comparison. The proportion of ears with complete clearance of ear wax was higher in the active treatment group (22%) compared with the no treatment group (5%) after five days of treatment (risk ratio (RR) 4.09, 95% confidence interval (CI) 1.00 to 16.80); one study; 117 ears; NNTB = 8) (low-quality evidence).Active treatment versus water or salineWe found no evidence of a difference in the proportion of patients (or ears) with complete clearance of ear wax when the active treatment group was compared to the water or saline group (RR 1.47, 95% CI 0.79 to 2.75; three studies; 213 participants; 257 ears) (low-quality evidence). Two studies applied drops for five days, but one study only applied the drops for 15 minutes. When we excluded this study in a sensitivity analysis it did not change the result.Water or saline versus no treatmentThis comparison was only addressed in the single study cited above (active versus no treatment) and there was no evidence of a difference in the proportion of ears with complete wax clearance when comparing water or saline with no treatment after five days of treatment (RR 4.00, 95% CI 0.91 to 17.62; one study; 76 ears) (low-quality evidence).Active treatment A versus active treatment BSeveral single studies evaluated 'head-to-head' comparisons between two active treatments. We found no evidence to show that one was superior to any other.Subgroup analysis of oil-based active treatments versus non-oil based active treatmentsWe found no evidence of a difference in this outcome when oil-based treatments were compared with non-oil-based active treatments.
PRIMARY OUTCOME
adverse effects: discomfort, irritation or painOnly seven studies planned to measure and did report this outcome. Only two (141 participants;176 ears) provided useable data. There was no evidence of a significant difference in the number of adverse effects between the types of ear drops in these two studies. We summarised the remaining five studies narratively. All events were mild and reported in fewer than 30 participants across the seven studies (low-quality evidence).Secondary outcomesThree studies reported 'other' adverse effects (how many studies planned to report these is unclear). The available information was limited and included occasional reports of dizziness, unpleasant smell, tinnitus and hearing loss. No significant differences between groups were reported. There were no emergencies or serious adverse effects reported in any of the 10 studies.There was very limited or no information available on our remaining secondary outcomes.
AUTHORS' CONCLUSIONS
Although a number of studies aimed to evaluate whether or not one type of cerumenolytic is more effective than another, there is no high-quality evidence to allow a firm conclusion to be drawn and the answer remains uncertain.A single study suggests that applying ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all. However, we cannot conclude whether one type of active treatment is more effective than another and there was no evidence of a difference in efficacy between oil-based and water-based active treatments.There is no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics. Equally, there is also no evidence to show that using saline or water alone is better than no treatment.
Topics: Adult; Antipyrine; Benzocaine; Carbamide Peroxide; Carbonates; Cerumen; Child; Chlorobutanol; Choline; Dioctyl Sulfosuccinic Acid; Drug Combinations; Ear Canal; Ethanolamines; Humans; Hygiene; Peroxides; Pharmaceutical Solutions; Plant Oils; Potassium; Randomized Controlled Trials as Topic; Salicylates; Sodium Chloride; Surface-Active Agents; Urea; Water
PubMed: 30043448
DOI: 10.1002/14651858.CD012171.pub2 -
International Journal of Epidemiology Dec 2018High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically... (Meta-Analysis)
Meta-Analysis
BACKGROUND
High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically reviewed the evidence from experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents.
METHODS
A systematic search of the Medline, Embase, CINAHL and CENTRAL databases up to March 2017 was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies involving children or adolescents between 0 and 18 years of age were included. Random-effects meta-analyses were performed by pooling data across all studies, separately for experimental and observational studies, and restricting to studies with sodium intake and blood pressure measurement methods of high quality. Subgroup meta-analyses, sensitivity analyses and meta-regressions were conducted to investigate sources of heterogeneity and confounding. The dose-response relationship was also investigated.
RESULTS
Of the 6572 publications identified, 85 studies (14 experimental; 71 observational, including 60 cross-sectional, 6 cohort and 5 case-control studies) with 58 531 participants were included. In experimental studies, sodium reduction interventions decreased systolic blood pressure by 0.6 mm Hg [95% confidence interval (CI): 0.5, 0.8] and diastolic blood pressure by 1.2 mm Hg (95% CI: 0.4, 1.9). The meta-analysis of 18 experimental and observational studies (including 3406 participants) with sodium intake and blood pressure measurement methods of high quality showed that, for every additional gram of sodium intake per day, systolic blood pressure increased by 0.8 mm Hg (95% CI: 0.4, 1.3) and diastolic blood pressure by 0.7 mm Hg (95% CI: 0.0, 1.4). The association was stronger among children with overweight and with low potassium intake. A quasi-linear relationship was found between sodium intake and blood pressure.
CONCLUSIONS
Sodium intake is positively associated with blood pressure in children and adolescents, with consistent findings in experimental and observational studies. Since blood pressure tracks across the life course, our findings support the reduction of sodium intake during childhood and adolescence to lower blood pressure and prevent the development of hypertension.
Topics: Adolescent; Blood Pressure; Blood Pressure Determination; Child; Humans; Hypertension; Observational Studies as Topic; Overweight; Sodium Chloride, Dietary
PubMed: 29955869
DOI: 10.1093/ije/dyy121 -
World Journal of Gastroenterology Apr 2018To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations. (Meta-Analysis)
Meta-Analysis Review
AIM
To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations.
METHODS
A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31, 2017. The inclusion criteria were comparative, randomized controlled trials (RCTs) for deceased donor liver (DDL) allografts with adult and pediatric donors using the gold standard University of Wisconsin (UW) solution or histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) and Institut Georges Lopez (IGL-1) solutions. Fifteen RCTs (1830 livers) were included; the primary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1).
RESULTS
All trials were homogenous with respect to donor and recipient characteristics. There was no statistical difference in the incidence of PNF with the use of UW, HTK, CS and IGL-1 (RR = 0.02, 95%CI: 0.01-0.03, = 0.356). Comparing OGS-1 also failed to reveal any difference between UW, HTK, CS and IGL-1 (RR = 0.80, 95%CI: 0.80-0.80, = 0.369). Two trials demonstrated higher PNF levels for UW in comparison with the HTK group, and individual studies described higher rates of biliary complications where HTK and CS were used compared to the UW and IGL-1 solutions. However, the meta-analysis of the data did not prove a statistically significant difference: the UW, CS, HTK and IGL-1 solutions were associated with nearly equivalent outcomes.
CONCLUSION
Alternative solutions for UW yield the same degree of safety and effectiveness for the preservation of DDLs, but further well-designed clinical trials are warranted.
Topics: Adenosine; Allopurinol; Disaccharides; Electrolytes; Glucose; Glutamates; Glutathione; Graft Survival; Histidine; Humans; Insulin; Liver Transplantation; Mannitol; Odds Ratio; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Primary Graft Dysfunction; Procaine; Raffinose; Randomized Controlled Trials as Topic; Risk Factors; Time Factors; Treatment Outcome
PubMed: 29713134
DOI: 10.3748/wjg.v24.i16.1812