A Systematic Review of Screening Tests for Chronic Kidney Disease: An Accuracy Analysis

This systematic review was conducted to assess the diagnostic accuracy of chronic kidney disease screening tests in the general population. MEDLINE, EMBASE, Web of Science, Scopus, The Cochrane Library and ProQuest databases were searched for English-language publications up to November 2016. Two reviewers independently screened studies and extracted study data in standardized tables. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of all available screening methods were identified through included studies. Ten out of 1349 screened records included for final analysis. Sensitivities of the dipstick test with a cutoff value of trace were ranged from 37.1% to 69.4% and specificities from 93.7% to 97.3% for the detection of ACR>30 mg/g. The diagnostic sensitivities of the UAC>10 mg/dL testing was shown to vary from 40% to 87%, and specificities ranged from 75% to 96%. While the sensitivities of ACR were fluctuating between 74% and 90%, likewise the specificities were between 77% and 88%. Sensitivities for C-G, Grubb and Larsson equations were 98.9%, 86.2%, and 70.1% respectively. In the meantime the study showed specificities of 84.8%, 84.2% and 90.5% respectively for these equations. Individual studies were highly heterogeneous in terms of target populations, type of screening tests, thresholds used to detect CKD and variations in design. Results pointed to the superiority of UAC and dipstick over the other tests in terms of all parameters involved. The diversity of methods and thresholds for detection of CKD, necessitate considering the cost parameter along with the effectiveness of tests to scale-up an efficient strategy. [GMJ.2020;9:e1573]

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Meningoencephalitis associated with COVID-19: A systematic review

10.1101/2020.06.25.20140145 ◽

2020 ◽

Author(s):

Ritwick Mondal ◽

Upasana Ganguly ◽

Shramana Deb ◽

Gourav Shome ◽

Subhasish Pramanik ◽

...

Keyword(s):

Systematic Review ◽

English Language ◽

Final Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Neurological Involvement ◽

P Value ◽

Neurological Manifestations ◽

Medical Subject Headings ◽

Laboratory Findings

AbstractBackground and aimsWith the growing number of COVID-19 cases in recent times, the varied range of presentations is progressively becoming an addressing issue among clinicians. A significant set of patients with extra pulmonary symptoms has been reported worldwide. Neurological involvement in the form of altered mental status, loss of consciousness in considerable amounts has drawn attention of physicians all across the globe. Here we venture out to summarise the clinical profile, investigations and radiological findings among patients with SARS-CoV-2 associated meningoencephalitis in the form of a systematic review, which may aid clinicians in early diagnosis and prognostic evaluation of the disease.MethodologyThis review was carried out based on the existing PRISMA (Preferred Report for Systemic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase and Cochrane library and Preprint servers up till 10th June, 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes “SARS-COV-2”, “COVID-19”, “meningoencephalitis” etc. All peer reviewed, case control, case report, pre print articles satisfying our inclusion criteria were involved in the study. The inclusion prerequisites comprised of confirmed SARS-CoV-2 cases with neurological manifestations, previous cases of SARS-CoV, MERS-CoV with neurological involvement provided all the studies were published in English language. Quantitative data was expressed in mean+/-SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p value of <0.05 considered to be statistically significant.ResultsA total of 43 cases were involved from 24 studies after screening from databases and preprint servers, out of which 29 of them had completed investigation profile and were included in the final analysis. Clincial and Laboratory findings as well as neuroimaging findings (CT, MRI and MRS) revealed consistent presentations towards association of COVID-19 with meningoencephalitis. Epileptogenic pictures were also evident on EEG (electroencephalogram) findings.ConclusionSARS-CoV-2 has been isolated from CSF as well as cerebrum of cases with meningoencephalitis depicting the natural tendency of the virus to invade the central nervous system. Speculations about retrograde olfactory transport or alternative haematogenous spread seem to be correlating with above findings. This review may raise the index of suspicion about COVID-19 among clinicians while attending patients with neurological manifestations.

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Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001776 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001776

Author(s):

Unjali P Gujral ◽

Ram Jagannathan ◽

Siran He ◽

Minxuan Huang ◽

Lisa R Staimez ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

English Language ◽

Meta Analysis ◽

Glycosylated Hemoglobin ◽

Language Studies ◽

Risk Of Mortality ◽

Cochrane Database ◽

Design And Methods

IntroductionWe conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.Research design and methodsWe identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.ResultsImpaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110–125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100–125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%–6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%–6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).ConclusionPrediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.

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P0275SCOPE AND CONSISTENCY OF OUTCOME MEASURES FOR PHYSICAL FITNESS IN TRIALS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0275 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Dev Jegatheesan ◽

Richard Modderman ◽

Rathika Krishnasamy ◽

Allison Tong ◽

Jeff Coombes ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Fitness ◽

Exercise Capacity ◽

Outcome Measures ◽

Cochrane Library ◽

Randomised Trials ◽

Increased Risk ◽

Patient Reported

Abstract Background and Aims Impaired physical fitness is prevalent across the spectrum of kidney disease and is associated with an increased risk of mortality, progression to end-stage kidney disease, falls and hospitalisation. Physical fitness outcomes have been extensively reported in randomised trials involving patients with kidney disease. This study aimed to assess the scope and consistency of physical fitness outcomes and outcome measures reported in kidney disease trials. Method A systematic review of randomised trials reporting physical fitness outcomes in adults with chronic kidney disease not requiring kidney replacement therapy, receiving maintenance haemodialysis or peritoneal dialysis, and kidney transplant recipients was conducted. The scope, frequency and characteristics of physical fitness outcome measures were categorised and analysed. Trials were identified from MEDLINE, Embase and the Cochrane Library from March 2000 to March 2019. Results From 115 relevant trials, 171 outcome measures for 32 outcomes were identified and categorised into five domains of physical fitness: exercise capacity (reported in 83% of trials), physiological-metabolic (57%), neuromuscular fitness (52%), body composition (45%) and cardiorespiratory fitness (19%). Exercise capacity had 53 different outcome measures and at 15 separate time points. The most common outcome measures were the 6-minute walk test (29%), peak oxygen uptake (20%), 1-repetition maximum (19%) and hand-grip strength (11%), with marked inconsistency in the reporting of outcomes between trials. Outcomes were assessed by field-based tests (65%), lab-based tests (31%) and patient-reported measures (4%). Conclusion There is large heterogeneity in the reporting of physical fitness outcomes, with inconsistencies in the use of validated, relevant and patient-important outcome measures.

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Elevated Osteoprotegerin Concentration Predicts Increased Risk of Cardiovascular Mortality in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Kidney & Blood Pressure Research ◽

10.1159/000508978 ◽

2020 ◽

Vol 45 (4) ◽

pp. 565-575

Author(s):

Qing-xiu Huang ◽

Jian-bo Li ◽

Naya Huang ◽

Xiao-wen Huang ◽

Yan-lin Li ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Cardiovascular Death ◽

Cochrane Library ◽

Random Effects Models ◽

Hazard Ratios ◽

Increased Risk

Introduction: Studies have shown inconsistent results regarding the association between osteoprotegerin (OPG) concentration and cardiovascular mortality in patients with chronic kidney disease (CKD). This systematic review and meta-analysis aims to investigate the association between OPG concentration and cardiovascular mortality in patients with CKD. Methods: Between January 1970 and February 2020, the PubMed, EMBASE, and Cochrane Library databases were searched for eligible studies investigating the association between OPG concentration and cardiovascular mortality in patients with CKD. Pooled hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated using random effects models. Results: In total, 10 studies comprising 2,120 patients (including 1,723 receiving dialysis) with CKD were included. The included studies were considered to be of fair to high quality. Patients in the highest OPG concentration group had a significantly higher risk of cardiovascular mortality (4 studies; adjusted HR, 2.05; 95% CI, 1.39–3.00) than patients in the low OPG concentration group. An increase of 1 pmol/L in OPG concentration was associated with a 4% increased risk of cardiovascular mortality (6 studies; adjusted HR, 1.04; 95% CI, 1.02–1.07). Conclusion: Elevated OPG concentrations are associated with an increased risk of cardiovascular death in patients with CKD.

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Intradialytic physical exercise in chronic kidney disease: a systematic review of health outcomes

Archivos de Medicina del Deporte ◽

10.18176/archmeddeporte.00017 ◽

2020 ◽

Vol 37 (6) ◽

pp. 419-429

Author(s):

Diego Fernández-Lázaro ◽

Juan Mielgo-Ayuso ◽

María Paz Lázaro Asensio ◽

Alfredo Córdova Martínez ◽

Alberto Caballero-García ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Muscle Strength ◽

Health Outcomes ◽

General Term ◽

Cochrane Library ◽

Related Quality ◽

And Function

Introduction: Chronic kidney disease (CKD) is a general term for heterogeneous disorders that affect the structure and function of the kidney. Complications of CKD significantly limit exercise (Ex) tolerance by reducing functional capacity, endurance, and strength. However, the practice of regular Ex contributes to delaying the progression of CKD and stimulating improvements in health-related quality of life (HRQOL). Ex performed during the period of hemodialysis may be the best option when stimulating adherence and being under medical supervision. The purpose of the paper is to examine the effectiveness of intradialytic (iHD) Ex on health outcomes in patients with CKD by identifying the most appropriate component of Ex. Material and method: Systematic review, based on PRISMA guidelines, performing a structured search in Medline, SciELO and Cochrane Library Plus databases. Publications from the last 5 years relating iHD Ex and CKD up to 31 December 2019 were included. The methodological quality of the articles was evaluated using the McMaster critical review form. Results: We found 7 articles that described increases in endurance, upper and lower limb muscle strength, and HRQL of CKD patients providing emotional, social and psychological improvements. In addition, iHD Ex is able to control oxidative stress, inflammation, improve the lipid profile and stimulate endothelial progenitor cells, which together reduce the risk of mortality associated with multiple comorbidities in CKD patients, especially cardiovascular ones. Conclusions:Ex provides improvements in physical function and capacity, HRQL and biological markers. Aerobic Ex, muscle strength Ex and combined Ex programs are used.

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Chronic kidney disease in Low- and Middle- Income Countries: Protocol for a systematic review of diagnostic and prognostic models

10.1101/2021.04.24.21256041 ◽

2021 ◽

Author(s):

Edson J Ascencio ◽

Diego J Aparcana-Granda ◽

Rodrigo M Carrillo-Larco

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Data Extraction ◽

Screening Tests ◽

Prognostic Models ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

ABSTRACTBackgroundChronic Kidney Disease (CKD) is a highly prevalent condition with a large disease burden globally. In low- and middle-income countries (LMIC) the CKD screening challenges the health system. This systematic and comprehensive search of all CKD diagnostic and prognostic models in LMIC will inform screening strategies in LMIC following a risk-based approach.ObjectiveTo summarize all multivariate diagnostic and prognostic models for CKD in adults in LMIC.MethodsSystematic review. Without date or language restrictions we will search Embase, Medline, Global Health (these three through Ovid), SCOPUS and Web of Science. We seek multivariable diagnostic or prognostic models which included a random sample of the general population. We will screen titles and abstracts; we will then study the selected reports. Both phases will be done by two reviewers independently. Data extraction will be performed by two researchers independently using a pre-specified Excel form (CHARMS model). We will evaluate the risk of bias with the PROBAST tool.ConclusionThis systematic review will provide the most comprehensive list and critical appraisal of diagnostic and prognostic models for CKD available for the general population in LMIC. This evidence could inform policies and interventions to improve CKD screening in LMIC following a risk-based approach, maximizing limited resources and reaching populations with limited access to CKD screening tests. This systematic review will also reveal methodological limitations and research needs to improve CKD diagnostic and prognostic models in LMIC.

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Efficacy of coenzyme Q10 in patients with chronic kidney disease: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-029053 ◽

2019 ◽

Vol 9 (5) ◽

pp. e029053 ◽

Cited By ~ 2

Author(s):

Yongxing Xu ◽

Juan Liu ◽

Enhong Han ◽

Yan Wang ◽

Jianjun Gao

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Coenzyme Q10 ◽

Meta Analysis ◽

Plasma Concentrations ◽

Cochrane Library ◽

Ethical Approval ◽

Registration Number ◽

Two Stages

IntroductionCoenzyme Q10 (CoQ10) is a fat-soluble vitamin-like quinone that exerts antioxidative functions and is also an important factor in mitochondrial metabolism. Plasma concentrations of CoQ10 are depressed in patients with chronic kidney disease (CKD). CoQ10 supplement can reduce adverse cardiovascular events, improve mitochondrial function and decrease oxidative stress in patients with non-dialysis CKD and dialysis CKD. We performed this study as a systematic review to comprehensively assess the effect of CoQ10 supplement on patients with CKD.Methods and analysisThe present systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols guidelines. The MEDLINE, EMBASE and Cochrane library databases will be searched without language restrictions in December 2018. Two reviewers will independently screen the references in two stages: screening of the title/abstract and then of the full-text, to identify references meeting the inclusion criteria. A descriptive overview and tabular and/or graphical summaries will be generated, and directed content analysis will be carried out on the extracted data.Ethics and disseminationThis systematic review will evaluate the efficacy and safety of CoQ10 in patients with CKD. Ethical approval is not required for this study. The results of this systematic review will be presented in relevant conferences and published in a peer-review journal.PROSPERO registration numberCRD42019120201

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