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INTRODUCTION: In this systematic review and meta-analysis, we aimed to review available data and provide pooled estimates of the predictive performance of urinary chemokine (CC motif) ligand (uCCL14') for persistent (≥48 hours) severe acute kidney injury (PS-AKI). METHODS: We searched MEDLINE, PubMed, Cochrane Library, and EMBASE for studies published up to April 11, 2023. We considered all studies including adults and reporting on the ability of uCCL14 to predict PS-AKI as defined by AKI persisting for 48 or 72 hours. Data extraction was performed by one investigator using a standardized form. It was checked for adequacy and completeness by another investigator. RESULTS: After screening, we identified 13 relevant studies. Among those, four (561 patients) provided sufficient data regarding the outcome of interest and were included. Considering each study cut-off value, pooled sensitivity and specificity were 0.85 (95% CI: 0.77- 0.90, I2 = 34.1%) and 0.96 (95% CI: 0.94 - 0.98, I2 = 53.7%) respectively. Pooled positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 8.98 (95% CI: 4.92 - 16.37, I2 = 23%), 0.25 (95% CI: 0.17 - 0.37, I2 = 0%) and 14.98 (95% CI: 3.55 - 63.27, I2 = 72.9%) respectively. The area under the curve estimated by summary receiver operating characteristics was 0.86 (95% CI: 0.70 - 0.95). Heterogeneity induced by the threshold effect was low (Spearman correlation coefficient: -0.30 p-value = 0.62) but significant for non-threshold effect. Risk of bias and concern for applicability according to the QUADAS-2 criteria was generally low. High risk in the index test due to the absence of prespecified thresholds was a concern for most studies. CONCLUSION: Based on current evidence, uCCL14 appears to have a good predictive performance for the occurrence of PS-AKI. Interventional trials to study a biomarker-guided application of AKI care bundles and RRT are indicated.
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BACKGROUND: Strongyloidiasis is an infectious disease that can be fatal in immunocompromised patients. Patients with end-stage renal failure who are on dialysis have a considerably weakened immune system, and organ transplantation is a major risk factor for severe strongyloidiasis. Knowledge of the local epidemiology in tropical and subtropical areas is an essential prerequisite for designing an appropriate strategy to prevent this potentially lethal complication. In this study, we aimed to estimate the prevalence and associated risk factors of S. stercoralis infection in patients on dialysis in Cochabamba, Bolivia. METHODS: A cross-sectional study was carried out among patients undergoing haemodialysis in Cochabamba (elevation 2,500 m, temperate climate), collecting information on socio-demographic, lifestyle, and clinical variables, and using one coproparasitological technique (the modified Baermann technique) and one serological (ELISA) test for S.stercoralis diagnosis. RESULTS: In total, 149 patients participated in the study (mean age = 51.4 years, 48.3% male). End-stage renal disease was predominantly (59%) of hypertensive and/or diabetic origin. The positive serological prevalence was 18.8% (95% CI: 13.3%-25.9%). Based on the sensitivity and specificity of the ELISA test, the estimate of the actual prevalence was 15.1% (95% CI: 9.4%-20.7%). Stool samples of 105 patients (70.5%) showed a coproparasitological prevalence of 1.9% (95% CI: 0.52%-6.68%). No potential risk factors were significantly associated with S. stercoralis infection. CONCLUSIONS: We found a high seroprevalence of S. stercoralis in Bolivian patients undergoing haemodialysis in Cochabamba. We recommend presumptive antiparasitic treatment at regular intervals to avoid the potentially fatal complications of severe strongyloidiasis.
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Fallo Renal Crónico , Diálisis Renal , Strongyloides stercoralis , Estrongiloidiasis , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bolivia/epidemiología , Estudios Transversales , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/parasitologíaRESUMEN
With the rise of life-expectancy, the number of comorbidities can increase and lead to polypharmacy (≥ 5 drugs/day) and excessive polypharmacy (> 9 drugs/day). In order to define suitable therapeutic targets, it is essential to take into account the heterogeneity of this population which can be classified into 3 categoriesâ : robust, vulnerable or dependent. In this context, the concept of deprescription, which englobes the process of tapering or stopping drugs, aimed at improving patient outcomes, becomes an important therapeutic tool. In the context of hypertension, this approach seems to be a safe, provided that patients can benefit from regular monitoring. It must be considered in vulnerable and dependent patients or patients institutionalized in nursing homes. Although, scientific evidence slowly accumulates, its levels remain moderate. Finally, the deprescribing process, can also be applied in specifics situations in order to prevent adverse events, such as during a heat wave.
Avec le vieillissement de la population, le nombre de comorbidités augmente fréquemment et peut entraîner une polypharmacie (≥ 5 médicaments/jour) ou une polypharmacie excessive (> 9 médicaments/jour). Afin de définir des cibles thérapeutiques adaptées, il est primordial de tenir compte de l'hétérogénéité de cette population que l'on peut schématiquement classer en 3 catégoriesâ : robustes, vulnérables et dépendants. Dans ce contexte, la déprescription, le fait d'arrêter ou de réduire la dose d'un médicament, est une action importante qu'il faut connaître et maîtriser. Pour l'hypertension, cette démarche semble être une pratique sûre, à condition, toutefois, que les patients puissent bénéficier d'un suivi régulier. Elle doit être considérée pour les personnes vulnérables et dépendantes, ou les patients institutionnalisés en établissements médico-sociaux. Bien que les évidences scientifiques commencent à s'accumuler, celles-ci restent d'un niveau modéré. Finalement, la déprescription peut également être ponctuelle afin de prévenir les effets indésirables d'une situation particulière, comme lors d'une canicule.