A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease
Bibliographic record
Abstract
Introduction: Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk.We conducted a systematic review and metaanalysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events.Methods: MEDLINE, EMBASE, and EBM databases were searched.Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers.Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models.Results: A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included.Four intervention-comparator pairs were meta-analyzed.Quality of evidence ranged from very low to moderate.Kidney transplantation decreased cf-PWV (À0.70 m/s; CI: -1.3 to À0.11; P ¼ 0.02) and SBP (À8.3 mm Hg; CI: À13.2 to À3.3; P < 0.001) over pretransplantation.In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (À1.90 m/s; CI: À3.3 to À0.5); P ¼ 0.02) and SBP (À4.3 mm Hg; CI: À7.7 to À0.93); P ¼ 0.01) compared with clinical assessment alone.Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia (P # 0.01).Low calcium dialysate decreased cf-PWV (À1.70 m/s; CI: À2.4 to À1.0; P < 0.00001) without affecting SBP (À1.6 mm Hg; CI: À8.9 to 5.8; P ¼ 0.61).Intradialytic exercise compared with no exercise reduced cf-PWV (À1.13 m/s; CI: À2.2 to À0.03; P ¼ 0.04), but not SBP (þ0.5 mm Hg; CI: À9.5 to 10.4); P ¼ 0.93).Conclusions: Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD.The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.020 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".