1,721,093 research outputs found
How to read critically a prognostic cohort study
No full textIn nephrology, cohort studies are an abundant source of information. They are the ideal study design to answer clinical questions about prevalence, prognosis and aetiology. In this study, the evaluation of a cohort study to guide decisions about prognosis in clinical nephrology is discussed. © 2010 The Authors. Nephrology © 2010 Asian Pacific Society of Nephrology
Interventions for preventing bone disease in kidney transplant recipients (Withdrawn Paper. 2007, art. no. CD005015)
No full textBackground: Patients with chronic kidney disease have significant abnormalities of bone remodeling and mineral homeostasis and are at increased risk of fracture. The fracture risk for a kidney transplant recipient is four times that of the general population and higher than for a patient on dialysis. Randomised controlled trials (RCTs) report the use of bisphosphonates, vitamin Dsterols, calcitonin, and hormone replacement therapy to treat bone disease following transplantation. Objectives: To evaluate the use of interventions for treating bone disease following kidney transplantation. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), Cochrane Renal Group's specialised register, MEDLINE, EMBASE, reference lists, and conference proceedings abstracts without language restriction. Date of last search: May 2006 Selection criteria: RCTs and quasi-RCTs comparing different treatments for kidney transplant recipients of any age were selected. We excluded all other transplant recipients, including kidney-pancreas transplant recipients. Data collection and analysis: Two authors independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI) for dichotomous variables and mean difference (MD) for continuous outcomes. Main results: Twenty-four trials (1,299 patients) were included. No individual intervention (bisphosphonates, vitamin D sterol or calcitonin) was associated with a reduction in fracture risk compared with placebo. Combining results for all active interventions against placebo demonstrated any treatment of bone disease was associated with a reduction in the RR of fracture (RR 0.51, 95% CI 0.27 to 0.99). Bisphosphonates (any route), vitamin D sterol, and calcitonin all had a beneficial effect on the bone mineral density at the lumbar spine. Bisphosphonates and vitamin D sterol also had a beneficial effect on the bone mineral density at the femoral neck. Bisphosphonates had greater efficacy for preventing bone mineral density loss when compared head-to-head with vitamin D sterols. Few or no data were available for combined hormone replacement, testosterone, selective oestrogen receptor modulators, fluoride or anabolic steroids. Other outcomes including all-cause mortality and drug-related toxicity were reported infrequently. Authors' conclusions: Treatment with a bisphosphonate, vitamin D sterol or calcitonin after kidney transplantation may protect against immunosuppression-induced reductions in bone mineral density and prevent fracture. Adequately powered trials are required to determine whether bisphosphonates are better than vitamin D sterols for fracture prevention in this population. The optimal route, timing, and duration of administration of these interventions remains unknown. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
How to read a nephrology systematic review
No full textA systematic review provides the best summary of evidence for clinical decision-making in nephrology by summarizing all the primary studies that evaluate a specific clinical question. By using rigorous and pre-specified methods, conclusions about the overall effect of an intervention can be more reliable, precise and comprehensive in a systematic review than those derived from individual studies. In this article, we describe the key components of a systematic review and meta-analysis. We summarize the features of a systematic review that should be looked for when considering the accuracy and validity of its results - particularly when applying the outcomes of a systematic review to a clinical question. © 2010 Asian Pacific Society of Nephrology
Interventions for minimal change disease in adults with nephrotic syndrome
No full textBackground: Steroids have been used widely since the early 1970s for the treatment of adult-onset minimal change disease. The response rates to immunosuppressive agents in adult minimal change disease, especially steroids, are more variable than in children. The optimal agent, dose, and duration of treatment for the first episode of nephrotic syndrome, or for disease relapse(s) has not been determined. Objectives: To determine the benefits and harms of interventions for the nephrotic syndrome in adults caused by minimal change disease. Search strategy: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference articles and abstracts from conference proceedings, without language restriction. Search date: January 2007. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of any intervention for minimal change disease in adults over 18 years with the nephrotic syndrome were included. Studies comparing different routes, frequencies, and duration of immunosuppressive agents were selected. Studies comparing non-immunosuppressive agents were also assessed. Data collection and analysis: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and results were expressed as a relative risk (RR) for dichotomous outcomes, or mean difference (WMD) for continuous data with 95% confidence intervals (CI). Main results: Three RCTs (68 participants) were identified. All treatment comparisons contained only one study. No significant difference was found between prednisone compared with placebo for complete (RR 1.44, CI 0.95 to 2.19) and partial remission (RR 1.00, CI 0.07 to 14.45) of the nephrotic syndrome due to minimal change disease. There was no difference between intravenous methylprednisolone plus oral prednisone compared with oral prednisone alone for complete remission (RR 0.74, CI 0.50 to 1.08). Prednisone, compared with short-course intravenous methylprednisolone, increased the number of subjects who achieved complete remission (RR 4.95, CI 1.15 to 21.26). The lack of statistical evidence of efficacy associated with prednisone therapy was based on data derived from a single study that compared 'alternate-day prednisone' to no immunosuppression' with only a small number of participants in each group. No RCTs were identified comparing regimens in adults with a steroid-dependent or relapsing disease course or comparing treatments comprising alkylating agents, cyclosporine, tacrolimus, levamisole, or mycophenolate mofetil. Authors' conclusions: Further comparative studies are required to examine the efficacy of immunosuppressive agents for achievement of sustained remission of nephrotic syndrome caused by minimal change disease. Studies are also needed to evaluate treatments for adults with steroid-dependent or relapsing disease. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
Interventions for preventing bone disease in kidney transplant recipients: A systematic review of randomized controlled trials
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