scholarly journals Improvements in Fatigue at Higher Achieved Hemoglobin Levels Among Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Murilo Guedes ◽  
Camila R. Guetter ◽  
Lucas HO Erbano ◽  
Andre G. Palone ◽  
Jarcy Zee ◽  
...  

Abstract Background: The impact anemia treatment with erythropoietin stimulating agents (ESA) on health-related quality of life (HRQOL) in chronic kidney disease (CKD) patients is controversial, particularly regarding optimal hemoglobin (Hb) target ranges.Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCT) with ESA to estimate the effect of different Hb ranges on physical HRQOL and functionality. We searched PubMed, EMBASE, CENTRAL, PEDro, PsycINFO and Web of Science databases, until May 2019Two authors independently extracted data from studies.We included observational and RCTs that enrolled CKD patients undergoing anemia treatment with ESA with different achieved Hb levels among groups. We excluded studies with achieved Hb < 9 g/dL. For the meta-analysis, we included RCTs with control groups achieving Hb 10-11.5 g/dL and active groups with Hb >11.5 g/dL. We analyzed the standardized mean difference (SMD) between groups for physical HRQOL.Results: Among 8,171 studies, fifteen RCTs and five observational studies were included for the systematic review. We performed the meta-analysis in a subset of eleven eligible RCTs. For physical role and physical function, SMDs were 0.0875 [CI:-0.0025 – 0.178] and 0.08 [CI: -0.03 – 0.19], respectively. For fatigue, SMD was 0.16 [0.09 - 0.24]. Subgroup analysis showed that trials with greater achieved Hb had greater pooled effects sizes — 0.21 [0.07 - 0.36] for Hb > 13 g/dL vs. 0.09 [0.02 - 0.16] for Hb 11.5-13 g/dL. Proportion of older and long-term diabetic patients across studies were associated with lower effect sizes.Conclusion: Achieved hemoglobin higher than currently recommended targets is associated with small but clinically significant improvement in fatigue. Younger and non-diabetic patients may experience more pronounced benefits of higher Hb levels after treatment with ESAs.

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1660
Author(s):  
Danielle Francesca Aycart ◽  
Sofía Acevedo ◽  
Lucía Eguiguren-Jimenez ◽  
Jeanette Mary Andrade

Proteins, especially plant proteins, may reduce inflammation among adults with chronic kidney disease (CKD). This systematic review and meta-analysis were conducted to evaluate the effect protein types (animal or plant) have on inflammation markers (CRP, IL-6, TNF-α) among adults with varying stages of CKD. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was conducted to identify articles from inception until January 2021, utilizing six databases. Controlled trials that compared the effects of different protein types were analyzed using random-effects meta-analysis. Quality assessment and risk of bias of the included articles were assessed by using Cochrane risk of bias instrument and ROBINS-I. Out of the 10 studies that met the criteria, there was a decreasing trend in CRP levels when consuming plant proteins compared to animal proteins among non-dialysis participants. There was a statistically significant decrease when comparing animal proteins to unspecified proteins in CRP levels among dialysis participants [Hedges’ g = 2.11; 95% CI 1.12, 3.11; p ≤ 0.001], favoring unspecified proteins. Furthermore, animal proteins (eggs, red meat) showed increasing trends in CRP levels compared to whey protein isolate. Caution must be considered regarding these results as controlled, non-randomized, trials were included in the analysis, which may have contributed to high risk of bias. Future research should focus on protein types and the impact they have on kidney disease progression and inflammation markers.


Author(s):  
Renata Valle Pedroso ◽  
Miguel Adriano Sanchez-Lastra ◽  
Laura Iglesias Comesaña ◽  
Carlos Ayán

Background: Exercise performed at home could be a useful therapy for people with chronic kidney disease. This systematic review and meta-analysis aimed at describing the characteristics, main findings, methodological quality, and adherence rate reported in the existent randomized controlled trials that have provided information regarding the impact of home-based exercise programs on people with chronic kidney disease. Methods: Electronic databases (MEDLINE/PubMed, SPORTDiscus, Scopus, and CENTRAL) were searched up to April 2021, using the keywords: “Exercise”; “Home”; “Kidney Disease.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adopted. Jadad scale and Cochrane’s tool were used to assess the methodological quality and risk of bias. Results: Out of the 14 studies finally selected, 11 were included in the meta-analysis and most presented high methodological quality. The meta-analysis showed significant effects of home-based exercise on fitness and quality of life, but a little impact on renal function. Although exercise performed at home was mostly feasible and safe, adherence was not high and a considerable number of dropouts were observed. Conclusion: Home-based exercise has positive effects on the fitness’ level and on the quality of life on people with chronic kidney disease. Future studies are needed to identify whether exercise performed at home is a better physical therapy option than center-based exercise.


Renal Failure ◽  
2016 ◽  
Vol 38 (9) ◽  
pp. 1335-1346 ◽  
Author(s):  
Zhenchuan Lin ◽  
Chen Zhao ◽  
Qimei Luo ◽  
Xi Xia ◽  
Xueqing Yu ◽  
...  

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ling-Qiong He ◽  
Xu-Hong Wu ◽  
Yi-Qian Huang ◽  
Xiao-Yan Zhang ◽  
Long Shu

Abstract Background A number of studies have reported the association between dietary patterns and the risk of chronic kidney disease (CKD), however a consistent perspective hasn’t been established to date. Herein, we conducted this systematic review and meta-analysis of observational studies to assess the association between dietary patterns and CKD. Methods MEDLINE, EBSCO and references from eligible studies were searched for relevant articles published up to 9 May 2020 that examined the association of common dietary patterns and CKD. The heterogeneity among studies was assessed by Cochran’s Q test and I2 methods. Results Seventeen eligible studies, involving 149,958 participants, were included in our systematic review and meta-analysis. The highest compared with the lowest category of healthy dietary pattern was significantly associated with a lower risk of CKD (OR=0.69; CI: 0.57, 0.84; P=0.0001). A higher risk of CKD was shown for the highest compared with the lowest categories of Western-type dietary pattern (OR=1.86; CI: 1.21, 2.86; P=0.005). There were evidence of a lower risk of CKD in the highest compared with the lowest categories of light-moderate drinking pattern (OR=0.76; CI: 0.71, 0.81; P< 0.0001) and heavy drinking pattern (OR=0.67; CI: 0.56, 0.80; P< 0.0001). Conclusions The results of this systematic review and meta-analysis show that a healthy dietary pattern and alcohol drinking were associated with lower risk of CKD, whereas a Western-type dietary pattern was associated with higher risk of CKD.


PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254554
Author(s):  
Sultana Shajahan ◽  
Janaki Amin ◽  
Jacqueline K. Phillips ◽  
Cara M. Hildreth

Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.


2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Misghina Weldegiorgis ◽  
Mark Woodward

An amendment to this paper has been published and can be accessed via the original article.


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