The Impact of Intervention Strategies That Target Arterial Stiffness in End-stage Renal Disease: a Systematic Review Protocol

Overview

Journal Syst Rev

Publisher Biomed Central

Date 2016 Jul 20

PMID 27431798

Citations 3

Authors

Rosendo A Rodriguez

Beverley Shea

Richard Hae

Kevin D Burns

Affiliations

Soon will be listed here.

Abstract

Background/objectives: Vascular damage contributes to the high cardiovascular morbidity and mortality in end-stage renal disease (ESRD). Increased aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a strong and independent predictor of the cardiovascular risk in ESRD patients. Recently, there has been considerable interest in developing strategies to lessen the progression of arterial stiffness in ESRD patients using cf-PWV as a tool to monitor therapeutic responses, but their benefit on the long-term cardiovascular risk is not known. Appraisal of the effects of existing stiffness-based interventions on the cf-PWV would facilitate selecting optimal therapies to be tested in randomized clinical trials. The aim of this systematic review will be to evaluate the impact of arterial stiffness-based interventions on the cf-PWV in ESRD patients. Secondarily, for each intervention, we will determine the minimal duration needed to achieve a significant reduction of cf-PWV, the minimal cf-PWV reduction threshold or effect size, and adverse events.

Methods/design: This review will be conducted using MEDLINE, EMBASE, and EBM Reviews. We will select clinical trials and observational studies (cohort, case-control, and before/after studies and case series) that evaluated pharmacologic or non-pharmacologic interventions in which the primary effect is to improve structural and/or dynamic components of arterial stiffness in adults with stage 5 chronic kidney disease. The primary outcome of interest will be cf-PWV. Study selection and data collection will be performed by two reviewers. Validated tools will be used to assess the methodological quality and risk of bias among different study designs. We will describe all included citations according to study characteristics, methodological quality, and outcomes. Suitability for meta-analysis will be determined by the degree of clinical and statistical heterogeneity between studies. If appropriate, we will calculate effect estimates by obtaining the relative risks with 95 % confidence intervals pooled according to study design using a random effects model.

Discussion: This review will summarize evidence regarding effects of interventions targeting arterial stiffness in ESRD patients. Our results will inform clinicians and researchers on the type of existing arterial stiffness-based interventions for ESRD patients and their potential efficacy and safety, with a goal to guide future clinical trials aimed at reducing adverse cardiovascular events.

Systematic Review Registration: PROSPERO CRD42016033463.

Citing Articles

Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

Rodriguez R, Spence M, Hae R, Agharazii M, Burns K Can J Kidney Health Dis. 2020; 7:2054358120906974.

PMID: 32128224 PMC: 7036505. DOI: 10.1177/2054358120906974.

A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease.

Rodriguez R, Hae R, Spence M, Shea B, Agharazii M, Burns K Kidney Int Rep. 2019; 4(8):1109-1121.

PMID: 31440701 PMC: 6698308. DOI: 10.1016/j.ekir.2019.05.011.

Metabolic acidosis status and mortality in patients on the end stage of renal disease.

Raikou Md PhD V J Transl Int Med. 2017; 4(4):170-177.

PMID: 28191541 PMC: 5290893. DOI: 10.1515/jtim-2016-0036.

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