透析和肾移植患者的骨折风险：系统评价与荟萃分析方案
Fracture risk in dialysis and kidney transplanted patients: a protocol for systematic review and meta-analysis.
作者信息
Sidibé Aboubacar, Moore Lynne, Jean Sonia, Mac-Way Fabrice
机构信息
Centre de Recherche du CHU de Québec, Hôpital Hôtel-Dieu de Québec, Division of Nephrology, Endocrinology and Nephrology Axis, Faculty and Department of Medicine, Laval University, 10 McMahon, Québec City, Québec, G1R 2J6, Canada.
Centre de Recherche du CHU de Québec, Hôpital de l'Enfant-Jésus, Traumatology Axis, Medicine Faculty, Department of Social and Preventive Medicine, Laval University, Quebec, Canada.
出版信息
Syst Rev. 2017 Feb 22;6(1):37. doi: 10.1186/s13643-017-0416-8.
BACKGROUND
Chronic kidney disease (CKD) is associated with an increased risk of fracture and cardiovascular mortality. The risk of fracture in hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) is higher when compared to the general population. However, uncertainties remain about which group has the highest risk of fracture. We aim to identify the risk of fracture and cardiovascular mortality post-fracture in HD compared to PD or KT and in PD compared to KT population.
METHODS
We will conduct a systematic review of observational studies and randomized control trials on patients with CKD. Eligible studies will be searched on MEDLINE, Embase, Web of Science, Cochrane Library, and in gray literature. Two independent reviewers will screen all identified references in order to include studies reporting the risk of fracture without a comparator or comparing that risk in HD vs KT, PD vs KT, or HD vs PD. Studies comparing the risk of fracture in a renal replacement therapy group to general population or to non-dialyzed CKD patients will also be included. Data on study settings, population characteristics, intervention, comparator, and outcomes will be extracted. Study data will be summarized and analyzed in RevMan and SAS. Risk of bias in cohort design studies will be assessed with an adapted version of the ROBINS-I tool and by the Cochrane handbook tool for RCTs. The quality of evidence and strengths of recommendations will be evaluated by the Grading of Recommendations Assessment, Development and Evaluations (GRADE) tool. We will pool relative risks with random-effect models and Mantel-Haenszel methods. Subgroup and sensitive analysis are planned according to the intervention and comparator, study design, and type of fracture.
DISCUSSION
This review will provide new pooled data about fracture risk in dialysis and KT patients. Our results should guide the implementation of future preventive strategies targeting patients with the highest fracture risk. A pooled analysis of observational studies could be limited by a probable considerable heterogeneity among these studies.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42016037526.
背景
慢性肾脏病（CKD）与骨折风险增加及心血管疾病死亡率升高相关。与普通人群相比，血液透析（HD）、腹膜透析（PD）及肾移植（KT）患者的骨折风险更高。然而，关于哪一组骨折风险最高仍存在不确定性。我们旨在确定HD患者相较于PD或KT患者，以及PD患者相较于KT患者骨折后骨折和心血管疾病死亡率的风险。
方法
我们将对CKD患者的观察性研究和随机对照试验进行系统评价。将在MEDLINE、Embase、科学网、Cochrane图书馆及灰色文献中检索符合条件的研究。两名独立的评审员将筛选所有已识别的参考文献，以纳入报告无对照的骨折风险或比较HD与KT、PD与KT或HD与PD骨折风险的研究。比较肾脏替代治疗组与普通人群或未透析的CKD患者骨折风险的研究也将被纳入。将提取关于研究背景、人群特征、干预措施、对照及结局的数据。研究数据将在RevMan和SAS中进行汇总和分析。队列设计研究中的偏倚风险将使用ROBINS - I工具的改编版及Cochrane手册中RCT的工具进行评估。证据质量和推荐强度将通过推荐分级评估、制定与评价（GRADE）工具进行评估。我们将使用随机效应模型和Mantel - Haenszel方法汇总相对风险。计划根据干预措施和对照、研究设计及骨折类型进行亚组分析和敏感性分析。
讨论
本综述将提供关于透析和KT患者骨折风险的新汇总数据。我们的结果应指导针对骨折风险最高患者的未来预防策略的实施。观察性研究的汇总分析可能会受到这些研究之间可能存在的相当大异质性的限制。
系统评价注册
PROSPERO CRD42016037526。
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