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Interventions for improving sleep quality in people with chronic kidney disease (Protocol)
No full textThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
This review aims to look at the benefits and harms of interventions for improving sleep quality among adults and children with CKD
ORAL SYMPTOMS AND SALIVARY FUNCTION AND ASSOCIATION WITH MORTALITY IN HEMODIALYSIS PATIENTS: A PROSPECTIVE COHORT ANALYSIS (ORAL-D SUBSTUDY)
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Adherence to dietary guidelines in adults with end-stage kidney disease treated with haemodialysis: A sub-study of the DIET-HD Multinational Cohort Study
No full textSodium-glucose co-transporter protein 2(SGLT2) inhibitors for people with chronic kidney disease and diabetes
No full textBackground
Diabetes is associated with high risks of premature chronic kidney disease (CKD),cardiovascular diseases, cardiovascular death and impaired quality of life. People withdiabetes are more likely to develop kidney impairment, and approximately one in threeadults with diabetes have CKD. People with CKD and diabetes experience a substantiallyhigher risk of cardiovascular outcomes. Sodium-glucose co-transporter protein 2 (SGLT2)inhibitors have shown potential effects in preventing kidney and cardiovascular outcomes inpeople with CKD and diabetes. However, new trials are emerging rapidly, and evidencesynthesis is essential to summarising cumulative evidence.
Objectives
This review aimed to assess the benefits and harms of SGLT2 inhibitors for people withCKD and diabetes.
Search methods
We searched the Cochrane Kidney and Transplant Register of Studies up to 17 November2023 using a search strategy designed by an Information Specialist. Studies in the Registerare continually identified through regular searches of CENTRAL, MEDLINE, and EMBASE,conference proceedings, the International Clinical Trials Registry Platform (ICTRP) SearchPortal and ClinicalTrials.gov.
Selection criteria
Randomised controlled studies were eligible if they evaluated SGLT2 inhibitors versusplacebo, standard care or other glucose-lowering agents in people with CKD and diabetes.CKD includes all stages (from 1 to 5), including dialysis patients.
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Data collection and analysis
Two authors independently extracted data and assessed the study risk of bias. Treatmentestimates were summarised using random effects meta-analysis and expressed as a riskratio (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI).Confidence in the evidence was assessed using the Grading of RecommendationsAssessment, Development and Evaluation (GRADE) approach. The primary reviewoutcomes were all-cause death, 3-point and 4-point major adverse cardiovascular events(MACE), fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, and kidneyfailure.
Main results
Fifty-three studies randomising 65,241 people with CKD and diabetes were included.SGLT2 inhibitors with or without other background treatments were compared to placebo,standard care, sulfonylurea, dipeptidyl peptidase-4 (DPP-4) inhibitors, or insulin. In themajority of domains, the risks of bias in the included studies were low or unclear. No studiesevaluated the treatment in children or in people treated with dialysis. No studies comparedSGLT2 inhibitors with glucagon-like peptide-1 receptor agonists or tirzepatide.
Compared to placebo, SGLT2 inhibitors decreased the risk of all-cause death (20 studies,44,397 participants: RR 0.85, 95% CI 0.78 to 0.94; I
= 0%; high certainty) andcardiovascular death (16 studies, 43,792 participants: RR 0.83, 95% CI 0.74 to 0.93; I
=29%; high certainty).
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Compared to placebo, SGLT2 inhibitors probably make little or no difference to the risk offatal or nonfatal MI (2 studies, 13,726 participants: RR 0.95, 95% CI 0.80 to 1.14; I
= 24%;moderate certainty), and fatal or nonfatal stroke (2 studies, 13,726 participants: RR 1.07,95% CI 0.88 to 1.30; I
= 0%; moderate certainty). Compared to placebo, SGLT2 inhibitorsprobably decrease 3-point MACE (7 studies, 38,320 participants: RR 0.89, 95% CI 0.81 to0.98; I
= 46%; moderate certainty), and 4-point MACE (4 studies, 23,539 participants: RR0.82, 95% CI 0.70 to 0.96; I
= 77%; moderate certainty), and decrease hospital admissiondue to heart failure (6 studies, 28,339 participants: RR 0.70, 95% CI 0.62 to 0.79; I
= 17%;high certainty).
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Compared to placebo, SGLT2 inhibitors may decrease creatinine clearance (1 study, 132participants: MD -2.63 mL/min, 95% CI -5.19 to -0.07; low certainty) and probably decreasethe doubling of serum creatinine (2 studies, 12,647 participants: RR 0.70, 95% CI 0.56 to0.89; I
= 53%; moderate certainty). SGLT2 inhibitors decrease the risk of kidney failure (6studies, 11,232 participants: RR 0.70, 95% CI 0.62 to 0.79; I
= 0%; high certainty), andkidney composite outcomes (generally reported as kidney failure, kidney death with orwithout ≥ 40% decrease in estimated glomerular filtration rate (eGFR)) (7 studies, 36,380participants: RR 0.68, 95% CI 0.59 to 0.78; I
= 25%; high certainty) compared to placebo.
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Compared to placebo, SGLT2 inhibitors incur less hypoglycaemia (16 studies, 28,322participants: RR 0.93, 95% CI 0.89 to 0.98; I
= 0%; high certainty), and hypoglycaemiarequiring third-party assistance (14 studies, 26,478 participants: RR 0.75, 95% CI 0.65 to0.88; I
= 0%; high certainty), and probably decrease the withdrawal from treatment due toadverse events (15 studies, 16,622 participants: RR 0.94, 95% CI 0.82 to 1.08; I
= 16%;moderate certainty).
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The effects of SGLT2 inhibitors on eGFR, amputation and fracture were uncertain.
No studies evaluated the effects of treatment on fatigue, life participation, or lactic acidosis.
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The effects of SGLT2 inhibitors compared to standard care alone, sulfonylurea, DPP-4inhibitors, or insulin were uncertain.
Authors' conclusions
SGLT2 inhibitors alone or added to standard care decrease all-cause death, cardiovasculardeath, and kidney failure and probably decrease major cardiovascular events while incurringless hypoglycaemia compared to placebo in people with CKD and diabetes
Potassium binders for chronic hyperkalaemia in people with chronic kidney disease
Full text linkThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of potassium binders for treating chronic hyperkalaemia among adults and children with CKD
Continuous erythropoiesis receptor activator (CERA) for the anaemia of chronic kidney disease
No full textBackgroundContinuous erythropoiesis receptor activator (CERA) is a newer, longer acting ESA which might be preferred to other ESAs (epoetin or darbepoetin) based on its lower frequency of administration. Different dosing requirements and molecular characteristics of CERA compared with other ESAs may lead to different health outcomes (mortality, cardiovascular events, quality of life) in people with anaemia and chronic kidney disease (CKD).ObjectivesTo assess benefits and harms of CERA compared with other epoetins (darbepoetin alfa and epoetin alfa or beta) or placebo/ no treatment or CERA with differing strategy of administration for anaemia in individuals with CKD.Search methodsWe searched the Cochrane Kidney and Transplant Specialised Register to 13 June 2017 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials. gov.Selection criteriaWe included randomised controlled trials (RCTs) of at least three months' duration, comparing CERA with a different ESA (darbepoetin alfa or epoetin alfa or beta) or placebo or standard care or versus CERA with different strategies for administration in people with any stage of CKD.Data collection and analysisDatawere extracted by two independent investigators. We summarised patient-centred outcomes (all-cause and cardiovascular mortality, major adverse cardiovascular events, red cell blood transfusion, iron therapy, cancer, hypertension, seizures, dialysis vascular access thrombosis, drug injection-related events, hyperkalaemia and health-related quality of life and haemoglobin levels) using random effects meta-analysis. Treatment estimates were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean differences or standardized mean difference with 95% CI for continuous outcomes.Main resultsWe included 27 studies involving 5410 adults with CKD. Seven studies (1273 participants) involved people not requiring dialysis, 19 studies (4209 participants) involved people treated with dialysis and one study (71 participants) evaluated treatment in recipients of a kidney transplant. Treatment was given for 24 weeks on average. No data were available for children with CKD. Studies were generally at high or unclear risk of bias from allocation concealment and blinding of outcomes. Only two studies masked participants and investigators to treatment allocation. One study compared CERA with placebo, nine studies CERA with epoetin alfa or beta, nine studies CERA with darbepoetin alfa, and two studies compared CERA with epoetin alfa or beta and darbepoetin alfa. Three studies assessed the effects of differing frequencies of CERA administration and five assessed differing CERA doses.There was low certainty evidence that CERA had little or no effects on mortality (RR 1.07, 95% CI 0.73 to 1.57; RR 1.11, 95% CI 0.75 to 1.65), major adverse cardiovascular events (RR 5.09, 95% CI 0.25 to 105.23; RR 5.56, 95% CI 0.99 to 31.30), hypertension (RR 1.01, 95% CI 0.75 to 1.37; RR 1.00, 95% CI 0.79 to 1.28), need for blood transfusion (RR 1.02, 95% CI 0.72 to 1.46; RR 0.94, 95% CI 0.55 to 1.61), or additional iron therapy (RR 1.03, 95% CI 0.91 to 1.15; RR 0.99, 95% CI 0.95 to 1.03) compared to epoetin alfa/beta or darbepoetin alfa respectively. There was insufficient evidence to compare the effect of CERA to placebo on clinical outcomes. Only one low quality study reported that CERA compared to placebo might lead to little or no difference in the risk of major cardiovascular events (RR 2.97, 95% CI 0.31 to 28.18) and hypertension ((RR 0.73, 95% CI 0.35 to 1.52). There was low certainty evidence that different doses (higher versus lower) or frequency (twice versus once monthly) of CERA administration had little or no different effect on all-cause mortality (RR 3.95, 95% CI 0.17 to 91.61; RR 0.97, 95% CI 0.56 to 1.66), hypertension (RR 0.45, 95% CI 0.08 to 2.52; RR 0.85, 95% CI 0.60 to 1.21), and blood cell transfusions (RR 4.16, 95% CI 0.89 to 19.53; RR 0.91, 95% CI 0.51 to 1.62). No studies reported comparative treatment effects of different ESAs on health-related quality of life.Authors' conclusionsThere is low certainty evidence that CERA has little or no effects on patient-centred outcomes compared with placebo, epoetin alfa or beta or darbepoetin alfa for adults with CKD. The effects of CERA among children who have CKD have not studied in RCTs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Psychosocial interventions for preventing and treating depression in dialysis patients
Full text linkBackground: People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review first published in 2005. Objectives: To assess the effect of using psychosocial interventions versus usual care or a second psychosocial intervention for preventing and treating depression in patients with ESKD treated with dialysis. Search methods: We searched Cochrane Kidney and Transplant's Register of Studies up to 21 June 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs of psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. We assessed effects of interventions on changes in mental state (depression, anxiety, cognition), suicide, health-related quality of life (HRQoL), withdrawal from dialysis treatment, withdrawal from intervention, death (any cause), hospitalisation and adverse events. Data collection and analysis: Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess evidence certainty. We estimated treatment effects using random-effects meta-analysis. Results for continuous outcomes were expressed as a mean difference (MD) or as a standardised mean difference (SMD) when investigators used different scales. Dichotomous outcomes were expressed as risk ratios. All estimates were reported together with 95% confidence intervals (CI). Main results: We included 33 studies enrolling 2056 participants. Twenty-six new studies were added to this 2019 update. Seven studies originally excluded from the 2005 review were included as they met the updated review eligibility criteria, which have been expanded to include RCTs in which participants did not meet criteria for depression as an inclusion criterion. Psychosocial interventions included acupressure, cognitive-behavioural therapy, counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice-recording of a psychological intervention. The duration of study follow-up ranged between three weeks and one year. Studies included between nine and 235 participants. The mean study age ranged between 36.1 and 73.9 years. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies respectively. One study reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in seven studies. Twelve studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and 21 studies were at low risk of other potential sources of bias. Cognitive behavioural therapy probably improves depressive symptoms measured using the Beck Depression Inventory (4 studies, 230 participants: MD -6.10, 95% CI -8.63 to -3.57), based on moderate certainty evidence. Cognitive behavioural therapy compared to usual care probably improves HRQoL measured either with the Kidney Disease Quality of Life Instrument Short Form or the Quality of Life Scale, with a 0.5 standardised mean difference representing a moderate effect size (4 studies, 230 participants: SMD 0.51, 95% CI 0.19 to 0.83), based on moderate certainty evidence. Cognitive behavioural therapy may reduce major depression symptoms (one study) and anxiety, and increase self-efficacy (one study). Cognitive behavioural therapy studies did not report hospitalisation. We found low-certainty evidence that counselling may slightly reduce depressive symptoms measured with the Beck Depression Inventory (3 studies, 99 participants: MD -3.84, 95% CI -6.14 to -1.53) compared to usual care. Counselling reported no difference in HRQoL (one study). Counselling studies did not measure risk of major depression, suicide, or hospitalisation. Exercise may reduce or prevent major depression (3 studies, 108 participants: RR 0.47, 95% CI 0.27 to 0.81), depression of any severity (3 studies, 108 participants: RR 0.69, 95% CI 0.54 to 0.87) and improve HRQoL measured with Quality of Life Index score (2 studies, 64 participants: MD 3.06, 95% CI 2.29 to 3.83) compared to usual care with low certainty. With moderate certainty, exercise probably improves depression symptoms measured with the Beck Depression Inventory (3 studies, 108 participants: MD -7.61, 95% CI -9.59 to -5.63). Exercise may reduce anxiety (one study). No exercise studies measured suicide risk or withdrawal from dialysis. We found moderate-certainty evidence that relaxation techniques probably reduce depressive symptoms measured with the Beck Depression Inventory (2 studies, 122 participants: MD -5.77, 95% CI -8.76 to -2.78). Relaxation techniques reported no difference in HRQoL (one study). Relaxation studies did not measure risk of major depression or suicide. Spiritual practices have uncertain effects on depressive symptoms measured either with the Beck Depression Inventory or the Brief Symptom Inventory (2 studies, 116 participants: SMD -1.00, 95% CI -3.52 to 1.53; very low certainty evidence). No differences between spiritual practices and usual care were reported on anxiety (one study), and HRQoL (one study). No study of spiritual practices evaluated effects on suicide risk, withdrawal from dialysis or hospitalisation. There were few or no data on acupressure, telephone support, meditation and adverse events related to psychosocial interventions. Authors' conclusions: Cognitive behavioural therapy, exercise or relaxation techniques probably reduce depressive symptoms (moderate-certainty evidence) for adults with ESKD treated with dialysis. Cognitive behavioural therapy probably increases health-related quality of life. Evidence for spiritual practices, acupressure, telephone support, and meditation is of low certainty. Similarly, evidence for effects of psychosocial interventions on suicide risk, major depression, hospitalisation, withdrawal from dialysis, and adverse events is of low or very low certainty
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