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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 -
Journal of Diabetes Research 2022Chronic kidney disease (CKD) is a main health problem associated with increased risk of cardiovascular disease, morbidity, and mortality. Recent studies shown that the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic kidney disease (CKD) is a main health problem associated with increased risk of cardiovascular disease, morbidity, and mortality. Recent studies shown that the progression of CKD may be related to the change of intestinal flora. Resistant starch (RS) is a type of dietary fiber that can act as a substrate for microbial fermentation. Some studies have found that the supplementation of RS can improve the intestinal flora disorder in CKD patients. However, the specific effect of RS on CKD patients remains controversial.
OBJECTIVE
We designed this meta-analysis to identify and assess the effects of RS on patients with CKD.
METHODS
A comprehensive search of MEDLINE, Embase, Web of Science, and Cochrane systematic review databases was conducted in January 2020, and all new trials were updated in August 2021. Randomized trials were collected to assess the effects of RS on patients with CKD. The weighted average effect size of the net change was calculated by using the random-effects model.
RESULTS
The meta-analysis included 8 studies involving 301 participants. RS intake significantly reduced serum indolephenol sulfate (IS), blood phosphorus, IL-6, and uric acid levels in dialysis patients. The mean difference (MD) of serum IS ( = 0.0002) in the dialysis subgroup was -12.57 mol/L (95% CI: -19.28, -5.86 mol/L). The MD of blood phosphorus ( = 0.03) was -0.39 mg/dl (95% CI: -0.78, -0.01 mg/dl). The MD of serum uric acid ( = 0.004) between the dialysis subgroup and the nondialysis subgroup was -31.58 mmol/L (95% CI: -52.99, -10.17 mmol/L). The mean difference (MD) of IL-6 ( = 0.02) in the dialysis subgroup was -1.16 mol/L (95% CI: -2.16, -0.16 mol/L). However, there was no significant change of RS on hs-CRP, serum creatinine, blood urea nitrogen (BUN), blood paracresol sulfate, and blood lipid.
CONCLUSIONS
The intake of RS reduced the serum IS, serum phosphorus, IL-6, and uric acid levels significantly in dialysis patients, while hs-CRP, serum creatinine, BUN, serum paracresol sulfate, and blood lipid showed no significant changes.
Topics: C-Reactive Protein; Creatinine; Humans; Interleukin-6; Phosphorus; Renal Insufficiency, Chronic; Resistant Starch; Sulfates; Uric Acid
PubMed: 35899018
DOI: 10.1155/2022/1861009 -
The Cochrane Database of Systematic... Apr 2014Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth.
OBJECTIVES
The primary objective was to assess whether physical activity programs in preterm infants improve bone mineralization and growth and reduce the risk of fracture.The secondary objectives included other potential benefits in terms of length of hospital stay, skeletal deformities and neurodevelopmental outcomes, and adverse events.Subgroup analysis:• Given that the smallest infants are most vulnerable for developing osteopenia (Bishop 1999), a subgroup analysis was planned for infants with birth weight < 1000 g.• Calcium and phosphorus intake may affect an infant's ability to increase bone mineral content (Kuschel 2004). Therefore, an additional subgroup analysis was planned for infants receiving different amounts of calcium and phosphorus, along with full enteral feeds as follows. ∘ Below 100 mg/60 mg calcium/phosphorus or equal to/above 100 mg/60 mg calcium/phosphorus per 100 mL milk. ∘ Supplementation of calcium without phosphorus. ∘ Supplementation of phosphorus without calcium.
SEARCH METHODS
The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. The search included the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 9), MEDLINE, EMBASE, CINAHL (1966 to March 2013), and cross-references, as well as handsearching of abstracts of the Society for Pediatric Research and the International Journal of Sports Medicine.
SELECTION CRITERIA
Randomized and quasi-randomized controlled trials comparing physical activity programs (extension and flexion, range-of-motion exercises) versus no organized physical activity programs in preterm infants.
DATA COLLECTION AND ANALYSIS
Data collection, study selection, and data analysis were performed according to the methods of the CNRG.
MAIN RESULTS
Eleven trials enrolling 324 preterm infants (gestational age 26 to 34 weeks) were included in this review. All were small (N = 16 to 50) single-center studies that evaluated daily physical activity for three and one-half to eight weeks during initial hospitalization. Methodological quality and reporting of included trials were variable.Four trials demonstrated moderate short-term benefits of physical activity for bone mineralization at completion of the physical activity program. The only trial assessing long-term effects on bone mineralization showed no effect of physical activity administered during initial hospitalization on bone mineralization at 12 months corrected age. Meta-analysis from four trials demonstrated a positive effect of physical activity on daily weight gain (weighted mean difference (WMD) 2.21 g/kg/d, 95% confidence interval (CI) 1.23 to 3.19). Data from four trials showed a positive effect on linear growth (WMD 0.12 cm/wk, 95% CI 0.01 to 0.24) but not on head growth (WMD -0.03 cm/wk, 95% CI -0.14 to 0.08) during the study period. Only one trial reported on fractures (this outcome did not occur in intervention and control groups) and complications of preterm birth (no significant differences between intervention and control groups). None of the trials assessed other outcomes relevant to this review.
AUTHORS' CONCLUSIONS
Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants. Data are inadequate to allow assessment of harm or long-term effects. Current evidence does not support the routine use of physical activity programs in preterm infants. Further trials incorporating infants with a high baseline risk of osteopenia are required. These trials should address adverse events, long-term outcomes, and the effects of nutritional intake (calories, protein, calcium, phosphorus).
Topics: Bone Density; Bone Diseases, Metabolic; Calcification, Physiologic; Humans; Infant; Infant, Newborn; Infant, Premature; Motor Activity; Musculoskeletal Manipulations; Randomized Controlled Trials as Topic; Weight Gain
PubMed: 24752440
DOI: 10.1002/14651858.CD005387.pub3 -
The Turkish Journal of Gastroenterology... Feb 2014To present the causes of acute liver failure in Turkey. (Review)
Review
BACKGROUND/AIMS
To present the causes of acute liver failure in Turkey.
MATERIALS AND METHODS
[corrected] International and national medical research databanks were searched for publications related to acute liver failure and originating from Turkey. Patients in the databank of acute liver failure of our center were also added to this literature search. Patients were evaluated for age, gender, etiology, treatment modality, and outcomes.
RESULTS
A total of 308 patients were analyzed. Hepatitis A (20.9%) for children and hepatitis B (34.7%) for adults were the most common causes of acute liver failure. Cryptogenic (18%) and metabolic (14%) reasons were the followings. Wilson's disease was the most common cause of metabolic diseases. Mushroom intoxication was the most frequent factor of toxic liver failure for both adults and children (13%). Firework intoxication, including yellow phosphorus, is an indigenous factor. Anti-tuberculosis agents (3.2%) were the main cause of drug-induced acute liver failures (9%). Paracetamol was responsible for only 0.7% of all acute liver failures. Survival of the transplanted patients (n=118) was better than the non-transplanted patients (n=178) (65% vs. 36% respectively, p<0.001) CONCLUSION: Preventable causes of acute liver failure in Turkey include hepatitis viruses and intoxication. Active vaccination and public awareness can decrease the number of acute liver failures. Paracetamol is not an emerging reason for acute liver failure in Turkey now, but selling it over the counter may increase the risks.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Liver Failure, Acute; Male; Middle Aged; Turkey; Young Adult
PubMed: 24918128
DOI: 10.5152/tjg.2014.4231 -
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 -
The American Journal of Clinical... Sep 2009Despite growing consumer demand for organically produced foods, information based on a systematic review of their nutritional quality is lacking. (Review)
Review
BACKGROUND
Despite growing consumer demand for organically produced foods, information based on a systematic review of their nutritional quality is lacking.
OBJECTIVE
We sought to quantitatively assess the differences in reported nutrient content between organically and conventionally produced foodstuffs.
DESIGN
We systematically searched PubMed, Web of Science, and CAB Abstracts for a period of 50 y from 1 January 1958 to 29 February 2008, contacted subject experts, and hand-searched bibliographies. We included peer-reviewed articles with English abstracts in the analysis if they reported nutrient content comparisons between organic and conventional foodstuffs. Two reviewers extracted study characteristics, quality, and data. The analyses were restricted to the most commonly reported nutrients.
RESULTS
From a total of 52,471 articles, we identified 162 studies (137 crops and 25 livestock products); 55 were of satisfactory quality. In an analysis that included only satisfactory-quality studies, conventionally produced crops had a significantly higher content of nitrogen, and organically produced crops had a significantly higher content of phosphorus and higher titratable acidity. No evidence of a difference was detected for the remaining 8 of 11 crop nutrient categories analyzed. Analysis of the more limited database on livestock products found no evidence of a difference in nutrient content between organically and conventionally produced livestock products.
CONCLUSIONS
On the basis of a systematic review of studies of satisfactory quality, there is no evidence of a difference in nutrient quality between organically and conventionally produced foodstuffs. The small differences in nutrient content detected are biologically plausible and mostly relate to differences in production methods.
Topics: Acids; Crops, Agricultural; Food Analysis; Food, Organic; Humans; Nitrogen; Nutritive Value; Phosphorus
PubMed: 19640946
DOI: 10.3945/ajcn.2009.28041 -
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 -
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 -
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 -
The Journal of Clinical Endocrinology... Dec 2014The distinctive presentation of primary hyperparathyroidism (PHPT) in adults and youths suggest that PHPT is a fundamentally different disease in these two groups. (Comparative Study)
Comparative Study Meta-Analysis Review
CONTEXT
The distinctive presentation of primary hyperparathyroidism (PHPT) in adults and youths suggest that PHPT is a fundamentally different disease in these two groups.
OBJECTIVE
To understand the difference in PHPT between adults and youths we compared the biochemistry of PHPT in these two groups.
DESIGN
This study is a systematic review and meta-analysis of retrospective studies published 1966-2014 on PHPT.
DATA SOURCES
All studies were obtained through Medline (1966-2014).
STUDY SELECTION AND DATA EXTRACTION
Only studies that included post-surgical subjects and that explicitly described biochemical results from more than one decade were included. Data were extracted from each article to generate the mean and SE for multiple biochemical parameters.
DATA SYNTHESIS
We analyzed 16 studies describing 268 unique youths and 2405 adults with PHPT. Youths with PHPT had significantly (P < .05) greater serum and urinary calcium than adults with PHPT (3.2 ± 0.1 mmol/L vs 2.8 ± 0.0 mmol/L for serum calcium, and 9.95 ± 1.26 mmol/d vs 7.15 ± 0.56 mmol/d for urine calcium, [mean ± SEM]). There were no significant differences in serum intact PTH, phosphorus, or alkaline phosphatase.
CONCLUSIONS
Juvenile PHPT has greater hypercalcemia and hypercalciuria than adult PHPT at similar concentrations of serum intact PTH. These observations suggest that there are differences in the pathophysiology of PHPT between juvenile and adult patients who reflect an apparent decrease in the sensitivity of the parathyroid adenoma to negative feedback by calcium and increased sensitivity of target tissues to the effects of PTH.
Topics: Adolescent; Adult; Aged; Aging; Child; Humans; Hyperparathyroidism, Primary; Middle Aged
PubMed: 25181388
DOI: 10.1210/jc.2014-2268