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Cochrane Database of Systematic Reviews

مداخلاتی برای پائین آوردن سطح هموسیستئین پلاسما در بیماران دیالیزی

Información

DOI:
https://doi.org/10.1002/14651858.CD004683.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 31 mayo 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Riñón y trasplante

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Sagar U Nigwekar

    Correspondencia a: Division of Nephrology, Massachusetts General Hospital, Scholars in Clinical Sciences Program, Harvard Medical School, Boston, USA

    [email protected]

    [email protected]

  • Amy Kang

    Sydney Medical School, The University of Sydney, Sydney, Australia

    Renal and Metabolic Division, The George Institute for Global Health, The University of Sydney, Camperdown, Australia

  • Sophia Zoungas

    Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia

  • Alan Cass

    Renal and Metabolic Division, The George Institute for Global Health, The University of Sydney, Camperdown, Australia

    Menzies School of Health Research, Casuarina, Australia

  • Martin P Gallagher

    Renal and Metabolic Division, The George Institute for Global Health, The University of Sydney, Camperdown, Australia

  • Satyarth Kulshrestha

    Department of Nephrology, University of Iowa Carver College of Medicine, Iowa City, USA

  • Sankar D Navaneethan

    Baylor College of Medicine, Houston, USA

  • Vlado Perkovic

    Renal and Metabolic Division, The George Institute for Global Health, The University of Sydney, Camperdown, Australia

  • Giovanni FM Strippoli

    Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia

    Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

    Medical Scientific Office, Diaverum, Lund, Sweden

    Diaverum Academy, Bari, Italy

    Sydney School of Public Health, The University of Sydney, Sydney, Australia

  • Meg J Jardine

    Renal and Metabolic Division, The George Institute for Global Health, The University of Sydney, Camperdown, Australia

    Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia

Contributions of authors

  1. Draft the protocol: AC, MG, MJ, AK, SK, SDN, SN, TN, VP

  2. Study selection: MJ, AK, SK, SDN, SN, VP,

  3. Extract data from studies: MJ, SK, SDN, SN, VP

  4. Enter data into RevMan: MJ, SN

  5. Carry out the analysis: MJ, SK, SDN, SN, TN, VP

  6. Interpret the analysis: MJ, SK, SDN, SN, TN, VP, GS, SZ

  7. Draft the final review: MJ, SK, SDN, SN, TN, VP

  8. Disagreement resolution: AC, MG, MJ, AK, SK, SDN, SN, TN, VP, GS, SZ

  9. Update the review: AC, MG, MJ, AK, SK, SDN, SN, TN, VP, GS, SZ

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Clinical Scientist in Nephrology award from the American Kidney Fund, USA.

    Sagar U Nigwekar

Declarations of interest

  • Sagar U Nigwekar: none known

  • Amy Kang: none known

  • Sophia Zoungas: I have received speaker honoria from Servier, MSD, Novo Nordisk, Sanofi Aventis, Johnson and Johnson and Astra Zeneca/BMS. I have served on external advisory boards for MSD, Amgen, AbbVie, Novo Nordisk, Novartis, Takeda, Sanofi Aventis and Astra Zeneca.

  • Alan Cass: The Menzies School of Health Research has received unconditional research funding from AMGEN, Merck and Novartis for research in chronic kidney disease in Indigenous populations

  • Martin P Gallagher: Martin Gallagher has received competitive research funding from the Royal Australasian College of Physicians and the Australian National Health and Medical Research Council in the last 36 months.

  • Satyarth Kulshrestha: none known

  • Sankar D Navaneethan: none known

  • Vlado Perkovic: none known

  • Giovanni FM Strippoli: Institutional support from AIfa‐italian medicines agenda for Cedose trial funding (ESA dose); employment by Diaverum, renal service provider for dialysis

  • Meg J Jardine: is supported by a NHMRC Career Development Fellowship and National Heart Foundation Future Leader Fellowship.

Acknowledgements

We would like to thank the referees for their comments and feedback during the preparation of this review.

Version history

Published

Title

Stage

Authors

Version

2016 May 31

Interventions for lowering plasma homocysteine levels in dialysis patients

Review

Sagar U Nigwekar, Amy Kang, Sophia Zoungas, Alan Cass, Martin P Gallagher, Satyarth Kulshrestha, Sankar D Navaneethan, Vlado Perkovic, Giovanni FM Strippoli, Meg J Jardine

https://doi.org/10.1002/14651858.CD004683.pub4

2009 Apr 15

Interventions for lowering plasma homocysteine levels in dialysis patients

Protocol

Sagar U Nigwekar, Alan Cass, Martin P Gallagher, Meg J Jardine, Amy Kang, Satyarth Kulshrestha, Sankar D Navaneethan, Vlado Perkovic, Giovanni FM Strippoli, Sophia Zoungas

https://doi.org/10.1002/14651858.CD004683.pub3

2004 Jan 26

Interventions for lowering plasma homocysteine levels in dialysis patients

Protocol

Kevan Polkinghorne, Pauline Branley, Peter G Kerr

https://doi.org/10.1002/14651858.CD004683

Differences between protocol and review

In the protocol, we mentioned N‐acetyl cysteine as an intervention that lowers serum homocysteine levels to be considered for this review. Although it has this effect there are significant other effects including anti‐oxidant effects from this intervention and since this review is focused on interventions that primarily reduce homocysteine, we decided to not include studies that evaluated N‐acetyl cysteine in the ESKD setting in this review. Our search identified only four such studies (Ali 2003; Nascimento 2010; Scholze 2004; Tepel 2003; Thaha 2006).

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Flow diagram showing study selection
Figuras y tablas -
Figure 1

Flow diagram showing study selection

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 2 Secondary outcomes, outcome: 2.1 all‐cause mortality
Figuras y tablas -
Figure 4

Funnel plot of comparison: 2 Secondary outcomes, outcome: 2.1 all‐cause mortality

Comparison 1 Primary outcome, Outcome 1 Cardiovascular mortality.
Figuras y tablas -
Analysis 1.1

Comparison 1 Primary outcome, Outcome 1 Cardiovascular mortality.

Comparison 2 Secondary outcomes, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 2.1

Comparison 2 Secondary outcomes, Outcome 1 All‐cause mortality.

Comparison 2 Secondary outcomes, Outcome 2 Myocardial infarction (fatal and non fatal).
Figuras y tablas -
Analysis 2.2

Comparison 2 Secondary outcomes, Outcome 2 Myocardial infarction (fatal and non fatal).

Comparison 2 Secondary outcomes, Outcome 3 Coronary revascularisation.
Figuras y tablas -
Analysis 2.3

Comparison 2 Secondary outcomes, Outcome 3 Coronary revascularisation.

Comparison 2 Secondary outcomes, Outcome 4 Stroke.
Figuras y tablas -
Analysis 2.4

Comparison 2 Secondary outcomes, Outcome 4 Stroke.

Comparison 2 Secondary outcomes, Outcome 5 Deep venous thrombosis and pulmonary embolism.
Figuras y tablas -
Analysis 2.5

Comparison 2 Secondary outcomes, Outcome 5 Deep venous thrombosis and pulmonary embolism.

Comparison 2 Secondary outcomes, Outcome 6 Thrombosis of dialysis access.
Figuras y tablas -
Analysis 2.6

Comparison 2 Secondary outcomes, Outcome 6 Thrombosis of dialysis access.

Comparison 2 Secondary outcomes, Outcome 7 Adverse events.
Figuras y tablas -
Analysis 2.7

Comparison 2 Secondary outcomes, Outcome 7 Adverse events.

Comparison 1. Primary outcome

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cardiovascular mortality Show forest plot

4

1186

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.70, 1.22]

Figuras y tablas -
Comparison 1. Primary outcome
Comparison 2. Secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

6

2447

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.89, 1.11]

2 Myocardial infarction (fatal and non fatal) Show forest plot

4

1510

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.66, 1.62]

3 Coronary revascularisation Show forest plot

2

1160

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.22, 3.14]

4 Stroke Show forest plot

4

1510

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.57, 1.40]

5 Deep venous thrombosis and pulmonary embolism Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6 Thrombosis of dialysis access Show forest plot

2

1261

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.88, 1.14]

7 Adverse events Show forest plot

3

1248

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.51, 2.47]

Figuras y tablas -
Comparison 2. Secondary outcomes