Dataset Information

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis.

ABSTRACT:

Context

Metabolic syndrome (MetS) is documented to increase the risk of mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. Since obesity is a major component of MetS, this meta-analysis was conducted to determine the risk of all-cause mortality, cardiovascular disease (CVD) mortality, and cardiovascular disease events (CVE) associated with MetS in ESRD subjects.

Evidence acquisition

Eligible studies from inception to March 2017 assessing the clinical outcome of MetS in ESRD subjects were comprehensively searched in MEDLINE, EMBASE, and CENTRAL. ESRD participants treated with hemodialysis (HD) or peritoneal dialysis (PD) were included, but renal transplant subjects were excluded. Two authors independently assessed article quality and extracted the data. The primary outcome was all-cause mortality and, secondary outcomes were CVD death and CVE.

Results

Fifty full-text articles were reviewed and eight studies were included in the meta-analysis, based on the random effects model. ESRD subjects with MetS, as compared with the non-MetS, had significant increased risk of all-cause mortality (pooled RR = 1.92; 95% confidence interval [CI] 1.15 - 3.21; P = 0.01) and CVE (pooled RR = 6.42; 95% CI 2.00 - 20.58). Age, type of dialysis, triglycerides, and HDL-C were significant predictors of risk of mortality, based on univariate meta-regression analyses.

Conclusions

Metabolic syndrome is associated with an increased risk of all-cause mortality in ESRD patients.

SUBMITTER: Sanguankeo A

PROVIDER: S-EPMC6176464 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis.

Sanguankeo Anawin A Upala Sikarin S

International journal of endocrinology and metabolism 20180207 2

<h4>Context</h4>Metabolic syndrome (MetS) is documented to increase the risk of mortality in the general population. However, there are reports of lower mortality in end stage renal disease (ESRD) patients with obesity. Since obesity is a major component of MetS, this meta-analysis was conducted to determine the risk of all-cause mortality, cardiovascular disease (CVD) mortality, and cardiovascular disease events (CVE) associated with MetS in ESRD subjects.<h4>Evidence acquisition</h4>Eligible s ...[more]

PMID: 30323848

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Project description:Rationale & objectiveThe prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk.MethodsA systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565).ResultsForty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3-15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2-4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001).ConclusionsPatients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.

Project description:BackgroundBeta-blockers has been reported to improve all-cause mortality and cardiovascular mortality in patients receiving dialysis, but type of beta-blockers (i.e., high vs. low dialyzable) on patient outcomes remains unknown. This study aimed at assessing the outcomes of patients receiving dialyzable beta-blockers (DBBs) compared to those receiving non-dialyzable beta-blockers (NDBBs).MethodsWe searched the databases including PubMed, Embase, Cochrane, and ClinicalTrials.gov until 28 February 2022 to identify articles investigating the impact of DBBs/NDBBs among patients with renal failure receiving hemodialysis/peritoneal dialysis (HD/PD). The primary outcome was risks of all-cause mortality, while the secondary outcomes included risk of overall major adverse cardiac event (MACE), acute myocardial infarction (AMI) and heart failure (HF). We rated the certainty of evidence (COE) by Cochrane methods and the GRADE approach.ResultsAnalysis of four observational studies including 75,193 individuals undergoing dialysis in hospital and community settings after a follow-up from 180 days to six years showed an overall all-cause mortality rate of 11.56% (DBBs and NDBBs: 12.32% and 10.7%, respectively) without significant differences in risks of mortality between the two groups [random effect, aHR 0.91 (95% CI, 0.81-1.02), p = 0.11], overall MACE [OR 1.03 (95% CI, 0.78-1.38), p = 0.82], and AMI [OR 1.02 (95% CI, 0.94-1.1), p = 0.66]. Nevertheless, the pooled odds ratio of HF among patients receiving DBBs was lower than those receiving NDBB [random effect, OR 0.87 (95% CI, 0.82-0.93), p<0.001]. The COE was considered low for overall MACE, AMI and HF, while it was deemed moderate for all-cause mortality.ConclusionsThe use of dialyzable and non-dialyzable beta-blockers had no impact on the risk of all-cause mortality, overall MACE, and AMI among dialysis patients. However, DBBs were associated with significant reduction in risk of HF compared with NDBBs. The limited number of available studies warranted further large-scale clinical investigations to support our findings.

Dataset Information

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis.

Context

Evidence acquisition

Results

Conclusions

Publications

Metabolic Syndrome Increases Mortality Risk in Dialysis Patients: A Systematic Review and Meta-Analysis.

Similar Datasets

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