Surficial geologic map of the Des Moines Lobe of Iowa, Phase 5: Polk County

https://ir.uiowa.edu/igs_ofm/1030/thumbnail.jp

Effect of Vitamin D Receptor Activators on Glomerular Filtration Rate: A Meta-Analysis and Systematic Review

<div><p>Background</p><p>Vitamin D receptor activators (VDRAs) can protect against mineral bone disease, but they are reported to elevate serum creatinine (SCr) and may also reduce glomerular filtration rate (GFR).</p><p>Methods</p><p>We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to evaluate the effect of VDRAs on kidney function and adverse events. MEDLINE, EMBASE, the Cochrane Controlled Trials Register were searched for RCTs that evaluate vitamin D receptor activators (alfacalcidol, calcitriol, doxercalciferol, falecalcitriol, maxacalcitol and paricalcitol) up to March 2015.</p><p>Results</p><p>We included 31 studies, all of which were performed between 1976 and 2015, which enrolled 2621 patients. Patients receiving VDRAs had lower eGFR (weighted mean difference WMD -1.29 mL/min /1.73 m², 95% CI -2.42 to -0.17) and elevated serum creatinine (WMD 7.03 μmol/L, 95% CI 0.61 to 13.46) in sensitivity analysis excluding studies with dropout rate more than 30%. Subgroup analysis of the 5 studies that not use SCr-based measures did not indicated lower GFR in the VDRAs group(WMD -0.97 mL/min/1.73 m2, 95% CI -4.85 to 2.92). Compared with control groups, there was no difference in all-cause mortality (relative risk RR 1.41, 95% CI 0.58 to 3.80), cardiovascular disease (RR 0.84, 95% CI 0.42 to 1.71), and severe adverse events (RR 1.15, 95% CI 0.75 to 1.77) for the VDRAs groups. Episodes of hypercalcemia (RR 3.29, 95% CI 2.02 to 5.38) were more common in the VDRAs group than in the control group.</p><p>Conclusions</p><p>Administration of VDRAs increased serum creatinine levels. Subgroup analysis of studies that did not use SCr-based measures did not indicate a lower GFR in the VDRA group. Future studies with non-SCr-based measures are needed to assess whether the mild elevations of serum creatinine are of clinical significance.</p></div

Forest plot comparison of serum creatinine changes, according to type of vitamin D receptor activators.

<p>Weighted mean difference in serum creatinine (umol/L) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Forest plot comparison of serum creatinine changes, according to baseline eGFR level.

<p>Weighted mean difference in serum creatinine (umol/L) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Procedure used for the trial selection.

<p>RCT = Randomized controlled trial.</p

Forest plot comparison of eGFR changes, according to baseline eGFR level.

<p>Weighted mean difference in eGFR (ml/min) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Forest plot comparison of serum creatinine changes by excluding studies with high dropout rates.

<p>Weighted mean difference in serum creatinine (umol/L) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Forest plot comparison of serum creatinine changes for each type of vitamin D receptor activators.

<p>Weighted mean difference in serum creatinine (umol/L) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Forest plot comparison of eGFR changes, according to type of vitamin D receptor activators.

<p>Weighted mean difference in eGFR (ml/min) in patients who received VDRAs compared with control therapy. Weights are from random effects analysis.</p

Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis

<p><b>Background and aims</b>: The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases.</p> <p><b>Methods</b>: PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated.</p> <p><b>Results</b>: Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85–0.94, 0.7–0.89, and 0.82–0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8–0.86), 0.79 (95%CI = 0.7–0.85), and 0.82 (95%CI = 0.72–0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82–0.88), 0.8 (95%CI = 0.68–0.88), and 0.8 (95%CI = 0.6–0.92) for any varices, and 0.86 (95%CI = 0.83–0.89), 0.86 (95%CI = 0.76–0.92), and 0.61 (95%CI = 0.35–0.83) for high-risk varices, respectively.</p> <p><b>Conclusions</b>: LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.</p