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Accurate GFR in obesity—protocol for a systematic review

BACKGROUND: Obesity is increasing globally. Chronic kidney disease (CKD) is strongly associated with obesity. Kidney function is commonly estimated with equations using creatinine (such as CKD-EPI equation) which is a product of muscle metabolism. Decisions about categorizing CKD, planning modality...

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Autores principales: Sriperumbuduri, Sriram, Dent, Robert, Malcolm, Janine, Hiremath, Swapnil, Klein, Ran, White, Christine A., Brown, Pierre Antoine, Akbari, Ayub
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588895/
https://www.ncbi.nlm.nih.gov/pubmed/31228953
http://dx.doi.org/10.1186/s13643-019-1052-2
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author Sriperumbuduri, Sriram
Dent, Robert
Malcolm, Janine
Hiremath, Swapnil
Klein, Ran
White, Christine A.
Brown, Pierre Antoine
Akbari, Ayub
author_facet Sriperumbuduri, Sriram
Dent, Robert
Malcolm, Janine
Hiremath, Swapnil
Klein, Ran
White, Christine A.
Brown, Pierre Antoine
Akbari, Ayub
author_sort Sriperumbuduri, Sriram
collection PubMed
description BACKGROUND: Obesity is increasing globally. Chronic kidney disease (CKD) is strongly associated with obesity. Kidney function is commonly estimated with equations using creatinine (such as CKD-EPI equation) which is a product of muscle metabolism. Decisions about categorizing CKD, planning modality of renal replacement therapies, and adjusting dosages of medications excreted by the kidneys are done using these equations. However, it is not well appreciated that creatinine-based equations may not accurately estimate kidney function in obese individuals. We plan a systematic review of diagnostic studies which will compare estimating equations to actual measured kidney function. METHODS: We will systematically search electronic bibliographic databases including MEDLINE, EMBASE, and the Cochrane Library with no restrictions on language or specific dates. The search terms will be adapted for the different databases using a combination of Medical Subject Heading and relevant keywords contained in titles and abstracts. Our preliminary search strategy using Cochrane, MEDLINE, and EMBASE databases have identified 190, 1246, and 1660 citations, respectively. For all studies selected, we will extract information on general study characteristics, study participant (age, sex, ethnicity, weight, height, BMI, BSA), type and protocol of reference standard utilized, the index test studied, the methodology of measurement of index test, categories of GFR, the proportion of eGFR within 10, 20, 30, 40, and 50% of measured GFR, and bias between eGFR and measured GFR. If the quality of methods and risk of bias are adequate, we will perform a meta-analysis. We will assess the heterogeneity using the χ(2) and the I(2) statistics to examine whether the estimates from studies included could be pooled. Sensitivity and multivariate meta-regression analyses will be performed to assess the effects of clinical factors and socio-demographic characteristics reported in included studies on the meta-analytic estimates. All analysis will be performed using the Comprehensive Meta-analysis software. DISCUSSION: This systematic review might help to inform clinicians on the best equation to use in patients with obesity and CKD for staging of CKD and for medication dosing. If no equation is deemed suitable, this review will form a basis for future studies of GFR in obese individuals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018104345 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13643-019-1052-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-65888952019-07-08 Accurate GFR in obesity—protocol for a systematic review Sriperumbuduri, Sriram Dent, Robert Malcolm, Janine Hiremath, Swapnil Klein, Ran White, Christine A. Brown, Pierre Antoine Akbari, Ayub Syst Rev Protocol BACKGROUND: Obesity is increasing globally. Chronic kidney disease (CKD) is strongly associated with obesity. Kidney function is commonly estimated with equations using creatinine (such as CKD-EPI equation) which is a product of muscle metabolism. Decisions about categorizing CKD, planning modality of renal replacement therapies, and adjusting dosages of medications excreted by the kidneys are done using these equations. However, it is not well appreciated that creatinine-based equations may not accurately estimate kidney function in obese individuals. We plan a systematic review of diagnostic studies which will compare estimating equations to actual measured kidney function. METHODS: We will systematically search electronic bibliographic databases including MEDLINE, EMBASE, and the Cochrane Library with no restrictions on language or specific dates. The search terms will be adapted for the different databases using a combination of Medical Subject Heading and relevant keywords contained in titles and abstracts. Our preliminary search strategy using Cochrane, MEDLINE, and EMBASE databases have identified 190, 1246, and 1660 citations, respectively. For all studies selected, we will extract information on general study characteristics, study participant (age, sex, ethnicity, weight, height, BMI, BSA), type and protocol of reference standard utilized, the index test studied, the methodology of measurement of index test, categories of GFR, the proportion of eGFR within 10, 20, 30, 40, and 50% of measured GFR, and bias between eGFR and measured GFR. If the quality of methods and risk of bias are adequate, we will perform a meta-analysis. We will assess the heterogeneity using the χ(2) and the I(2) statistics to examine whether the estimates from studies included could be pooled. Sensitivity and multivariate meta-regression analyses will be performed to assess the effects of clinical factors and socio-demographic characteristics reported in included studies on the meta-analytic estimates. All analysis will be performed using the Comprehensive Meta-analysis software. DISCUSSION: This systematic review might help to inform clinicians on the best equation to use in patients with obesity and CKD for staging of CKD and for medication dosing. If no equation is deemed suitable, this review will form a basis for future studies of GFR in obese individuals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018104345 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13643-019-1052-2) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-22 /pmc/articles/PMC6588895/ /pubmed/31228953 http://dx.doi.org/10.1186/s13643-019-1052-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Protocol
Sriperumbuduri, Sriram
Dent, Robert
Malcolm, Janine
Hiremath, Swapnil
Klein, Ran
White, Christine A.
Brown, Pierre Antoine
Akbari, Ayub
Accurate GFR in obesity—protocol for a systematic review
title Accurate GFR in obesity—protocol for a systematic review
title_full Accurate GFR in obesity—protocol for a systematic review
title_fullStr Accurate GFR in obesity—protocol for a systematic review
title_full_unstemmed Accurate GFR in obesity—protocol for a systematic review
title_short Accurate GFR in obesity—protocol for a systematic review
title_sort accurate gfr in obesity—protocol for a systematic review
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588895/
https://www.ncbi.nlm.nih.gov/pubmed/31228953
http://dx.doi.org/10.1186/s13643-019-1052-2
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