Predictive value of the conditions for the optimal dialysis initiation (Meta-analysis of observational studies)

2021 ◽  
Vol 25 (4) ◽  
pp. 42-47
Author(s):  
V. A. Dobronravov ◽  
A. V. Karunnaya
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Systematic Search ◽  
Dialysis Initiation ◽  
Patient Centered ◽  
Number Of Patients ◽  
Initiation Of Dialysis ◽  
Publica Tions

BACKGROUND. The survival of dialysis patients remains unsatisfactory. A number of observational studies have shown that the conditions of initiation of dialysis can influence long-term outcomes, including mortality.THE AIM. To compare the mortality of patients under predefined conditions of optimal (planned) and suboptimal (unplanned) dialysis initiation.METHODS. Using the MEDLINE and EMBASE databases from inception to June 2020, we conducted a systematic search for studies that examined the overall mortality of patients who met or did not meet the predefined conditions for an “optimal” start of renal replacement therapy (RRT): planned vs. unplanned onset; initiation of substitution therapy on permanent access vs. temporary; with priorobservation of the nephrologist vs. without it. As a result of a systematic search, subsequent analysis and selection of publica tions, 8 studies were included in the meta-analysis (total number of incident patients was 22755; 13680 patients met the conditions of the optimal dialysis start).RESULTS. All-cause mortality among patients with the conditions of suboptimal dialysis start was higher than in those with the optimal start (34.4 % vs. 46.6 %, p<0,001) with the increase in the relative risk (RR) of fatal outcome by 35.1 % (95 % confidence interval (CI) 30.8 %-39.4 %, p<0.0001). Estimated number of patients needed to start dialysis in the optimal conditions to prevent 1 death was 8 (95 % CI 7-9).CONCLUSION. The meta-analysis demonstrated the relationship between the urgent initiation of RRT, the use of temporary access for dialysis, and the lack of timely prior follow-up by a nephrologist with an increase in mortality. Prevention of dialysis initiation in these suboptimal conditions in real-world clinical practice can be an effective tool for improving patient-centered outcomes.

Hydroxyurea for β-Thalassemia Major: A Meta-Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4894-4894 ◽  
Author(s):  
Ali H. Algiraigri ◽  
Nicola A. Wright ◽  
Aliya Kassam
Keyword(s):  
Sample Size ◽  
Clinical Efficacy ◽  
Observational Studies ◽  
Response Rate ◽  
Meta Analysis ◽  
Thalassemia Major ◽  
Organ Damage ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background β-thalassemia major (β-TM) is one of the most common inherited diseases worldwide, characterized by a reduced ability to produce hemoglobin resulting in life-long transfusion-dependent anemia. Chronic transfusions carry significant risks such as infection, and result in iron overload that can cause significant multisystem organ damage. Hydroxyurea, an oral chemotherapeutic drug, is anticipated to decrease the need for transfusions, either completely or partially by raising hemoglobin levels and thus decreasing the short and long term complications of chronic transfusions. Objectives To evaluate the clinical efficacy and safety of hydroxyurea in β-thalassemia major (β-TM) patients of any age. Search strategy We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ongoing trials registers, and major preceding conferences. Hand searches were also conducted using reference lists from primary studies. All searches were updated to June 5, 2014. Selection criteria Randomized controlled trials (RCTs) and observational studies (sample size ≥ 5) assessing the clinical efficacy of hydroxyurea alone for three months or longer, for the treatment of patients with β-TM were included. Data collection and analysis Two authors acted as reviewers and independently assessed study quality and extracted data from the included studies. Authors of included studies were contacted if further information was required. β-TM includes the classical β-TM as well as severe hemoglobin E/β thalassemia, both of which are characterized by lifelong transfusion needs. The effect size was estimated as a proportion (those showing response to treatment over the total number treated) and reported as overall response rate (ORR) or complete response rate (CRR). ORR was defined as ≥ 50% reduction in transfusion need and CRR was defined as complete cessation of regular transfusion. All data was analyzed using Stata, Version 13.0. Results A total of 10 observational studies involving 620 patients were included. Hydroxyurea was associated with a statistically significant decrease in transfusion need with CRR of 36% (95% CI, 23-50%) and ORR of 66% (95% CI, 52-79%). All of the studies had several limitations, such as small sample size, lack of comparison group, under-reporting of data and methods, and being observational studies. Adverse events (AEs) were transient and improved with temporary cessation of the drug and/or adjustment of the dose. No long-term AEs, including cancer or end organ damage were reported. Authors’ conclusion Hydroxyurea appears to be effective in the management of β-TM by decreasing the need for chronic blood transfusions completely or partially in a significant number of patients. It appears to be well tolerated and associated with mild and transient AEs. Patients with β-TM may benefit from a trial of hydroxyurea, though large RCTs assessing efficacy should be done to confirm the findings of this meta-analysis. Disclosures Off Label Use: Hydroxyurea for β-Thalassemia.

scholarly journals Systematic Literature Review and Meta-Analysis of the Relationship Between Polyunsaturated and Trans Fatty Acids During Pregnancy and Offspring Weight Development

2021 ◽  
Vol 8 ◽  
Author(s):  
Xuan Ren ◽  
Birgitta Lind Vilhjálmsdóttir ◽  
Jeanett Friis Rohde ◽  
Karen Christina Walker ◽  
Suzanne Elizabeth Runstedt ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Birth Weight ◽  
Observational Studies ◽  
Trans Fatty Acids ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Neonatal Blood ◽  
The Relationship ◽  
Long Term Studies

Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and trans fatty acids (TFAs) may have an impact on offspring weight development. We conducted a systematic review and meta-analysis according to PRISMA guidelines to evaluate whether levels of these fatty acids during pregnancy influenced offspring weight development. Randomized controlled trials (RCTs) with DHA and/or EPA supplementation or cohort studies, which examined levels of DHA, EPA, or TFAs in maternal or neonatal blood samples and recorded offspring weight, were included. Overall, 27 RCTs and 14 observational studies were identified. The results showed that DHA and/or EPA supplementation doses &gt;650 mg/day resulted in slightly higher birth weight (MD 87.5 g, 95% CI 52.3–122.6, n = 3,831) and combined BMI and BMI z score at 5–10 years (SMD 0.11, 95% CI 0.04–0.18, n = 3,220). These results were rated as moderate quality. Results from the observational studies were generally inconsistent. High TFA levels during pregnancy seemed to be associated with lower birth weight. Finally, this review and meta-analysis supports a relationship between high maternal or neonatal DHA and/or EPA levels and higher offspring birth weight and weight in childhood. More high-quality long-term studies are still needed.

scholarly journals Providing care to long-term mechanically ventilated patients in Germany – Current situation and needs for action from the perspective of health professionals / Die Versorgung langzeitbeatmeter Patienten in Deutschland – Aktuelle Situation und Handlungsbedarfe aus der Sicht von Gesundheitsberufsangehörigen

2020 ◽  
Vol 7 (1) ◽  
pp. 53-65
Author(s):  
Yvonne Lehmann ◽  
Susanne Stark ◽  
Michael Ewers
Keyword(s):  
Health Professionals ◽  
Invasive Mechanical Ventilation ◽  
Life Quality ◽  
Control Mechanisms ◽  
Health Providers ◽  
Patient Centered ◽  
Patient Pathways ◽  
Number Of Patients

AbstractBackgroundThe number of patients depending on long-term invasive mechanical ventilation (IMV) has been increasing for several years. Anecdotal reports indicate heterogeneous health structures, opaque patient pathways, nontransparent and sometimes questionable practices in individual areas of care, inadequate quality standards and control mechanisms in Germany. However, there is hardly any empirical data on this topic.AimTo report findings from a qualitative study conducted as part of a complex research project to assess the appropriateness of care provided to IMV patients in Germany.MethodsThirteen semi-structured expert interviews were conducted with 22 health professionals providing care for IMV patients. The data analysis was conducted with MAXQDA according to the framework by Meuser and Nagel.ResultsInterviewees emphasized similar healthcare deficits. They considered health providers to be nontransparent and influenced by secondary interests. Quality of care is reported to be jeopardized by shortage of trained staff. Warranty of self-determination and participatory decision-making is not a matter of fact. Clarifying issues of sustaining life, quality of life and shaping the end of life is often ignored. The professionals are familiar with the patient pathways, allocation processes and responsibilities described in existing guidelines, but criticize the fact that they are not sufficiently binding. Accordingly, patient pathways are frequently individual results of experience-based, informal networking, and often left to chance.ConclusionsThe results point to a considerable need for action to reach an appropriate, integrated, patient-centered level of care for long-term IMV patients and ensure its quality.

scholarly journals Long-Term Safety of Hydroxyurea in Sickle Cell Anemia and Other Benign Diseases: Systematic Review and Meta-Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 560-560 ◽  
Author(s):  
Ali H. Algiraigri ◽  
Mansoor Radwi
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Observational Studies ◽  
Heart Diseases ◽  
Meta Analysis ◽  
Renal Stones ◽  
Benign Diseases ◽  
Cyanotic Congenital Heart Diseases

Background Hydroxyurea (HU) is an oral chemotherapeutic agent that has been used for the treatment of sickle cell anemia (SCA) and many other conditions. Although the efficacy of HU has been established in SCA, there is ambiguity regarding the long-term adverse events of this treatment. As significant risk such as secondary malignancies or myelodysplastic syndrome (MDS) have been linked to this drug but occur in small numbers across the various indications, we planned to pool the results from HU studies used in many conditions (excluding malignant and premalignant diseases) to obtain much wanted risk estimates. Objectives To evaluate the long-term safety (carcinogenicity) of HU therapy in people with SCA or any benign diseases (excluding malignant and premalignant diseases) of any age. Search strategy We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ongoing trials registers, and major preceding conferences. Hand searches were also conducted using reference lists from primary studies. All searches were updated to May 25 2014. Selection criteria Randomized controlled trials (RCTs) and observational studies (sample size ≥ 20 and mean/median follow up ≥ 2 years) assessing the toxicity of HU for the treatment of patients with any benign diseases were included. Data collection and analysis Two authors acted as reviewers and independently completed the search process, selected the studies, assessed study quality, and extracted data from the included studies. Authors of included studies were contacted if further information was required. Since the majority of the included studies were single-arm design with no control groups, the effect size was estimated as a proportion (events over patient-years on HU) and reported as overall cancer risk (OCR) for the included studies. All data was analyzed using comprehensive meta-analysis (CMA), version 2.0. Main results A total of 37 studies (3 RCTs and 34 observational studies) involving 3278 patients were included. We identified four benign diseases where HU has been used ≥ 2 years and met the inclusion criteria. These include SCA (26 studies), β-thalassemia (9 studies), cyanotic congenital heart diseases (one study), and renal stones (one study). HU was not associated with increased risk of cancers in the treated group with OCR of 0.2% (95% CI, 0.0-0.3%). Further to that, 12 studies or extension studies with ≥ 5 year follow up on HU showed stable result of 0.2%. This weighted effect size represent cancer incidence rate of 2 per 1000 which is not higher than the most recent published cancer incidence rate for all African-American or Whites, US 2005-2009 period. Acknowledging the differences between the two rates and they are not meant to be direct comparison, a useful representation can be extracted from them. Overall, there were 7 cases of malignancy/MDS were identified post relatively long-term use (≥ 2years) of HU in 3278 patients. In the narrative review, we identified another 13 cases of malignancies post HU use in hemoglobinopathy as described by different case reports and studies that did not meet our inclusion criteria with majority have been leukemia. The majority of the included studies had several limitations, such as small sample size, lack of comparison group, under-reporting of data and methods, and the majority having been observational studies. Authors’ conclusion The use of HU in treating patients with hemoglobinopathies does not appear to be associated with increase risk of secondary malignancies nor MDS despite being used for relatively long-term courses. However, ongoing long-term studies as well as updated national and international registries and other types of large database are highly needed to further consolidate this finding. Disclosures Off Label Use: Hydroxyurea for management of β-Thalassemia, Cyanotic congenital heart diseases, Renal stones, or Children with sickle cell anemia..

scholarly journals Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Alfonso J. Rodriguez-Morales ◽  
Jaime A. Cardona-Ospina ◽  
Estefanía Gutiérrez-Ocampo ◽  
Rhuvi Villamizar-Peña ◽  
Yeimer Holguin-Rivera ◽  
...  
Keyword(s):  
Observational Studies ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Clinical Manifestations ◽  
Clinical Infectious Disease ◽  
Imaging Features ◽  
Pooled Prevalence ◽  
Quantitative Analyses

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported. Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome. Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

scholarly journals Does antipsychotic drug use increase the risk of long term mortality? A systematic review and meta-analysis of observational studies

Oncotarget ◽  
2018 ◽  
Vol 9 (19) ◽  
pp. 15101-15110 ◽  
Author(s):  
Chunsong Yang ◽  
Zilong Hao ◽  
Jinhui Tian ◽  
Wei Zhang ◽  
Wenting Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Use ◽  
Antipsychotic Drug ◽  
Observational Studies ◽  
Meta Analysis ◽  
Long Term Mortality

scholarly journals Invited Commentary: The Disillusionment of Developmental Origins of Health and Disease (DOHaD) Epidemiology

2019 ◽  
Vol 189 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen E Gilman ◽  
Mady Hornig
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Developmental Origins ◽  
Short Term ◽  
Hyperactivity Disorder ◽  
Health And Disease ◽  
The Individual ◽  
Meta Analyses

Abstract The developmental origins of health and disease (DOHaD) model promises a greater understanding of early development but has left unresolved the balance of risks and benefits to offspring of medication use during pregnancy. Masarwa et al. (Am J Epidemiol. 2018;187(8):1817–1827) conducted a meta-analysis of the association between in utero acetaminophen exposure and risks of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A challenge of meta-analyzing results from observational studies is that summary measures of risk do not correspond to well-defined interventions when the individual studies adjusted for different covariate sets, which was the case here. This challenge limits the usefulness of observational meta-analyses for inferences about etiology and treatment planning. With that limitation understood, Masarwa et al. reported a 20%–30% higher risk of ADHD and ASD following prenatal acetaminophen exposure. Surprisingly, most of the original studies did not report diagnoses of ADHD or ASD. As a result, their summary estimates of risk are not informative about children’s likelihood of ADHD and ASD diagnoses. The long-term promise of DOHaD remains hopeful, but more effort is needed in the short-term to critically evaluate observational studies suggesting risks associated with medications used to treat conditions during pregnancy that might have adverse consequences for a developing fetus.

scholarly journals Risk of Dementia in Long-Term Benzodiazepine Users: Evidence from a Meta-Analysis of Observational Studies

2019 ◽  
Vol 15 (1) ◽  
pp. 9 ◽  
Author(s):  
Qian He ◽  
Xiaohua Chen ◽  
Tang Wu ◽  
Liyuan Li ◽  
Xiaofan Fei
Keyword(s):  
Observational Studies ◽  
Meta Analysis
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