Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. However, it is not well established how great the risk is for falls and fractures for the different stages of CKD compared to the general population. The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types of outcome. Ten studies focused on accidental falling; seventeen studies focused on hip, femur, and pelvis fractures; seven studies focused on vertebral fractures; and thirteen studies focused on any type of fracture without further specification. Generally, the risk of fractures increased when kidney function worsened, with the highest risks in the patients with stage 5 CKD or dialysis. This effect was most pronounced for hip fractures and any type of fractures. Furthermore, results on the association between CKD and accidental falling were contradictory. Compared to the general population, fractures are highly prevalent in patients with CKD. Besides more awareness of timely fracture risk assessment, there also should be more focus on fall prevention.

Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow-up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12-month follow-up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12-month follow-up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow-up period including welldefined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including costeffectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by subsequent exacerbations and remissions (1). Its prevalence is increasing worldwide, and AD is currently among the most common skin diseases in children (2). Itching, disturbed sleep, and time-consuming medical treatment regimens lead to a reduced experienced quality of life in patients with AD (3, 4).AD is a complex disease with several genetic and environmental factors involved (5). A genetic predisposition leads to an atopic constitution and a disturbed immune response which results in chronic inflammation and an impaired skin barrier (6, 7). In several eczema birth cohorts, the association between AD and the subsequent development of asthma and allergic sensitization has been established (8, 9). Prevalence of allergic sensitization in children with AD varies between countries, ranging from 52% in Belgium to 83% in Australia (8). Around 30% of children diagnosed with AD will develop asthma later in life (10). Among adults with AD, there is also great variation in prevalence of allergic sensitization and asthma diagnosis (11).Exposure to irritants and allergens, changes in physical environment (pollution, humidity), infections, and psychosocial or emotional factors are possible triggers for exacerbations (12). AD treatment is based on control of inflammation/infection, skin hydration, and trigger avoidance (13,14). Treatment approaches include anti-inflammatory therapy with topical immunosuppressives (dermatocorticosteroids, calcineurin inhibitors) and antimicrobial treatment, according to current guidelines (13,14). In more severe cases, phototh...