SP626A SYSTEMATIC REVIEW OF NON-PHARMACOLOGICAL INTERVENTIONS TO PROMOTE ADHERENCE TO DIETARY SALT AND FLUID INTAKE RESTRICTIONS IN END-STAGE KIDNEY DISEASE
Notice bibliographique
Résumé
INTRODUCTION AND AIMS: Dietary restriction of salt and fluid intake is an important strategy to prevent volume overload, a common complication in end-stage kidney disease. The aim of this study was to evaluate the effects of non-pharmacologic interventions to improve adherence to dietary salt and fluid restriction in patients with stage 5 CKD, including pre-dialysis patients and those on chronic hemodialysis (HD) or peritoneal dialysis (PD). METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) and quasi-RCTs in adults with stage 5 CKD was conducted. Electronic databases (MEDLINE, Embase, Cochrane) were searched without language restriction in December 2014 . Study selection was done by two independent authors. Mean differences (MD) were pooled using random effects meta-analysis. Primary outcomes were mortality, cardiovascular events, and quality of life. Secondary outcomes included interdialytic weight gain (IDWG), and blood pressure (BP). Risk of bias was assessed using the Cochrane Risk of Bias Tool. The GRADE approach was applied to assess certainty of evidence for each outcome. RESULTS: Seventeen studies assessing educational, behavioural, cognitive, or organizational interventions were included, with 15 studies in HD (N=1305 participants) and 2 studies in PD (N=135 participants). There were no studies in pre-dialysis patients, and no studies assessed mortality or cardiovascular events. Among studies reporting Short-Form 36 quality of life scores, there was overall improvement in physical role scores (MD, +12.42, 95% CI +5.29, +19.55) in educational and cognitive intervention groups compared with routine care, with no significant changes in other subscales. Among studies in HD patients, pooled results did not show a significant effect on IDWG (MD -0.11 kg, 95% CI -0.29, +0.07) and this was consistent across all interventions (low risk of bias; moderate certainty). Among HD studies reporting pre-HD BP, the pooled effect size showed a statistically significant reduction in systolic BP (MD -7.72 mmHg, 95% CI -12.88, -2.57) and diastolic BP (MD -4.12 mm Hg, 95% CI -7.91, -0.32), with greater effect in behavioural interventions than organizational interventions. There was insufficient evidence to make conclusions about the effect of interventions on fluid adherence, body weight, or BP in PD studies. CONCLUSIONS: There was moderate certainty evidence demonstrating minimal effect of interventions to promote adherence to salt/fluid restrictions on IDWG in chronic HD patients. Educational and cognitive interventions may improve quality of life in the domain of role limitations due to physical health problems, but the certainty of the evidence is low as studies had high risk of bias due to lack of blinding. Behavioural and organizational interventions may improve BP control in HD patients. Studies assessing mortality, cardiovascular events, and nutritional status were lacking. More RCTs of interventions in PD and non-dialysis stage 5 CKD populations are needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,012 | 0,010 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».