Fracture risk in dialysis and kidney transplanted patients: a protocol for systematic review and meta-analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".