scholarly journals Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (7) ◽  
pp. 3471
Author(s):  
Hyeon-Ju Lee ◽  
Youn-Jung Son
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Associated Factors ◽  
Meta Analysis ◽  
Screening Tools ◽  
Cochrane Library ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Hemodialysis is the most common type of treatment for end-stage renal disease (ESRD). Frailty is associated with poor outcomes such as higher mortality. ESRD patients have a higher prevalence of frailty. This systematic review and meta-analysis aimed to identify the prevalence and associated factors of frailty and examine whether it is a predictor of mortality among ESRD patients undergoing hemodialysis. Five electronic databases including PubMed, Embase, CINAHL, Web of Science, and Cochrane Library were searched for relevant studies up to 30 November 2020. A total of 752 articles were found, and seven studies with 2604 participants in total were included in the final analysis. The pooled prevalence of frailty in patients with ESRD undergoing hemodialysis was 46% (95% Confidence interval (CI) 34.2−58.3%). Advanced age, female sex, and the presence of diabetes mellitus increased the risk of frailty in ESRD patients undergoing hemodialysis. Our main finding showed that patients with frailty had a greater risk of all-cause mortality compared with those without (hazard ratio (HR): 2.02, 95% CI: 1.65−2.48). To improve ESRD patient outcomes, healthcare professionals need to assess the frailty of older ESRD patients, particularly by considering gender and comorbidities. Comprehensive frailty screening tools for ESRD patients on hemodialysis need to be developed.

scholarly journals Covid-19 in end-stage renal disease patients with renal replacement therapies: A systematic review and meta-analysis

2021 ◽  
Vol 15 (6) ◽  
pp. e0009156
Author(s):  
Tanawin Nopsopon ◽  
Jathurong Kittrakulrat ◽  
Kullaya Takkavatakarn ◽  
Thanee Eiamsitrakoon ◽  
Talerngsak Kanjanabuch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Case Fatality ◽  
Global Average ◽  
Specific Protocol ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background The novel coronavirus (COVID-19), caused by SARS-CoV-2, showed various prevalence and case-fatality rates (CFR) among patients with different pre-existing chronic conditions. End-stage renal disease (ESRD) patients with renal replacement therapy (RRT) might have a higher prevalence and CFR due to reduced immune function from uremia and kidney tropism of SARS-CoV-2, but there was a lack of systematic study on the infection and mortality of the SARS-CoV-2 infection in ESRD patients with various RRT. Methodology/Principal findings We searched five electronic databases and performed a systematic review and meta-analysis up to June 30, 2020, to evaluate the prevalence and case fatality rate (CFR) of the COVID-19 infection among ESRD patients with RRT. The global COVID-19 data were retrieved from the international database on June 30, 2020, for estimating the prevalence and CFR of the general population as referencing points. Of 3,272 potential studies, 34 were eligible studies consisted of 1,944 COVID-19 confirmed cases in 21,873 ESRD patients with RRT from 12 countries in four WHO regions. The overall pooled prevalence in ESRD patients with RRT was 3.10% [95% confidence interval (CI) 1.25–5.72] which was higher than referencing 0.14% global average prevalence. The overall estimated CFR of COVID-19 in ESRD patients with RRT was 18.06% (95% CI 14.09–22.32) which was higher than the global average at 4.98%. Conclusions This meta-analysis suggested high COVID-19 prevalence and CFR in ESRD patients with RRT. ESRD patients with RRT should have their specific protocol of COVID-19 prevention and treatment to mitigate excess cases and deaths.

scholarly journals Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis

2019 ◽  
Vol 35 (9) ◽  
pp. 1609-1618 ◽  
Author(s):  
Chien-Wei Huang ◽  
Min-Jing Lee ◽  
Liang-Jen Wang ◽  
Po-Tsang Lee ◽  
Yu-Kang Tu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Combination Therapy ◽  
Adverse Events ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients and impairs health and quality of life significantly. However, the optimal treatment of RLS in ESRD patients is uncertain and less studied compared with idiopathic RLS patients. Methods We conducted a systematic review and network meta-analysis to compare the efficacy and acceptability of treatments for RLS in ESRD patients. Randomized controlled trials (RCTs) by February 2019 in the PubMed, Cochrane Library, Embase and ClinicalTrials.gov were reviewed. RLS severity reduction was treated as treatment efficacy, and adverse events were treated as acceptable. Both outcomes were appraised using a random effects model expressed as standardized mean differences and odds ratios with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to obtain a hierarchy of interventions. Results A total of 12 RCTs were included, comprising 9 interventions and 498 participants. All the interventions significantly improved RLS severity without critical side effects compared with placebo. Gabapentin achieved the greatest decrease of RLS severity [standardized mean difference (SMD) = 1.95, 95% CI 0.81–3.09 (SUCRA: 79.3%)], despite its frequent adverse events [SMD = 0.18, 95% CI 0.02–1.50 (19.9%)]. The combination therapy of exercise plus dopamine agonist had better efficacy [SMD = 1.60, 95% CI 0.08–3.12 (59.8%)] and acceptability [SMD = 1.41, 95% CI 0.01–142.53 (63.9%)] compared with that of vitamin C plus vitamin E [SMD = 1.50, 95% CI 0.47–2.54 (56.6%); SMD = 0.32, 95% CI 0.04–2.86 (32.5%)]. Conclusions This network meta-analysis supports that gabapentin is the most effective treatment for RLS in ESRD patients. Exercise plus dopamine agonist is a favorable combination therapy concerning side effects. Future large RCTs with long-term treatment outcomes are necessary.

scholarly journals Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 ◽  
pp. 205435812090697
Author(s):  
Rosendo A. Rodriguez ◽  
Matthew Spence ◽  
Richard Hae ◽  
Mohsen Agharazii ◽  
Kevin D. Burns
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Aortic Stiffness ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Randomized Studies ◽  
Stage Renal Disease ◽  
End Stage

Background: Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of increased aortic stiffness, is a risk factor for cardiovascular events and all-cause mortality in end-stage renal disease (ESRD). To minimize the deleterious effects of an increased aortic stiffness in ESRD patients, several interventions have been developed and cf-PWV has been used to monitor responses. Objective: The aim of this study was to determine the effects of pharmacologic interventions that target aortic stiffness on cf-PWV and systolic blood pressure (SBP) in adults with ESRD. Study design: This study implements a systematic review and meta-analysis. Data sources: MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM databases were searched. Study eligibility, participants, and interventions: Randomized and non-randomized studies involving adults (>18 years) with ESRD of any duration, receiving or not renal replacement therapy (hemodialysis, peritoneal dialysis) and exposed to a pharmacologic intervention whose effects were assessed by cf-PWV. Methods: Study screening, selection, data extraction, and quality assessments were performed by 2 independent reviewers. Narrative synthesis and quantitative data analysis summarized the review. Results: We included 1027 ESRD participants from 13 randomized and 5 non-randomized studies. Most pharmacologic interventions targeted bone mineral metabolism disorder or hypertension. Treatment with vitamin D analogues or cinacalcet did not decrease cf-PWV or SBP over placebo or matched controls ( P > .05). Calcium-channel blockers (CCB) decreased cf-PWV and SBP compared with placebo or standard care ( P < .05). Renin-angiotensin system inhibitors did not show any advantage over placebo in decreasing cf-PWV ( P > .05). Limitations: Quality of evidence ranged from very low to moderate. Overall evidence was limited by the low number of studies, small sample sizes, and methodological inconsistencies. Conclusions: Pharmacologic interventions targeting aortic stiffness in ESRD have mixed effects on reducing cf-PWV, with some strategies suggesting potential benefit. The quality of evidence, however, is insufficient to draw definitive conclusions on their use to slow progression of aortic stiffness in ESRD. Further well-designed studies are needed to confirm these associations and their impact on cardiovascular outcomes in ESRD. Registered in PROSPERO (CRD42016033463)

scholarly journals Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis

2015 ◽  
Vol 30 (10) ◽  
pp. 1747-1766 ◽  
Author(s):  
Michelle R. Kaminski ◽  
Anita Raspovic ◽  
Lawrence P. McMahon ◽  
Giovanni F.M. Strippoli ◽  
Suetonia C. Palmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Lower Extremity Amputation ◽  
Foot Ulceration ◽  
Stage Renal Disease ◽  
End Stage ◽  
Extremity Amputation

scholarly journals Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Chen Gao ◽  
Chunyan Weng ◽  
Chenghai He ◽  
Jingli Xu ◽  
Liqiang Yu
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Local Anesthesia ◽  
End Stage Renal Disease ◽  
Meta Analysis ◽  
Primary Patency ◽  
Post Operative Pain ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Arteriovenous fistulae (AVF) are the hemodialysis access modality of choice for patients with end-stage renal disease. However, they have a high early failure rate. Good vascular access is essential to manage long-term hemodialytic treatment, but some anesthesia techniques directly affect venous diameter as well as intra- and post- operative blood flow. The main purpose of this meta-analysis was to compare the results of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease.Methods: We conducted a systematic review and meta-analysis to synthesize evidence from 7 randomized controlled trials (565 patients) and 2 observational studies (524 patients) aim to evaluate the safety and efficacy of regional anesthesia (RA) versus local anesthesia (LA) in AVF surgical construction.Results: Pooled data showed that RA was associated with higher primary patency rates than LA (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.24 - 2.84; P = 0.003; I 2 = 31%; Figure 2a). Additionally, brachial artery diameter was significantly increased in the RA versus LA group (mean difference [MD] = 0.83; 95% CI: 0.75 - 0.92; P < 0.001; I 2 = 97%) and the need for intra- as well as post- operative pain killers was significantly less (RA, p = 0.0363; LA, p = 0.0318). Moreover, operation duration was significantly reduced in the RA (67.5 ± 8.9 min) versus LA (134.7 ± 14.8 min) group (p = 0.0007).Conclusions: In conclusion, compared with LA, RA shows higher primary patency rates and it also associated with significantly better intra- as well as post- operative pain control, reduced operative times, which are extremely important in patients with end-stage renal disease and severe comorbidities.

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