Patients with chronic kidney disease have higher cardiovascular risk than general population, a fact that has been linked to high homocysteine levels. Folic acid supplementation can reduce homocysteine levels, which would reduce cardiovascular events. However, there is controversy about the clinical effects of this measure. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews comprising 13 trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded folic acid supplementation does not reduce the risk of myocardial infarction or stroke in patients with chronic kidney disease, and might have no effect on mortality.
Chronic kidney disease-mineral and bone disorder is prevalent. There is controversy regarding whether calcium-based phosphate binders or sevelamer - a non-calcium phosphate binder constitute a better therapeutic alternative. Searching in Epistemonikos database, which is maintained by screening multiple information sources, we identified 12 systematic reviews comprising 61 studies of which 41 correspond to randomized trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded sevelamer may decrease hypercalcemia, but with a higher incidence of gastrointestinal effects than calcium based phosphate binders. It is unclear if there are differences in mortality because the certainty of the evidence is very low.
Introducción: El sobrepeso y la obesidad son cada vez más prevalentes y colaboran a mayor riesgo cardiovascular. No existen estudios sobre estas patologías en la población atacameña, (tercer grupo más numeroso entre las etnias originarias en Chile). Objetivo: Evaluar niveles de sobrepeso y obesidad de la población de etnia atacameña y comparar el estado nutricional de atacameños ubicados en una región Rural (Alto el Loa), y una urbana (Calama).
Actitud y habilidades del médico residente de pediatría en la enseñanza de los médicos internos de pregrado, experiencia en hospitales públicos y privados al noroeste de México
The number of patients requiring renal replacement therapy has increased exponentially in recent years. However, there is still controversy regarding the best moment to initiate chronic dialysis. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews comprising 21 trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded delaying the initiation of dialysis probably does not increase mortality risk in chronic kidney disease and makes little or no difference in the risk of requiring a temporary catheter or having to check the vascular access.
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