Random-Effects Meta-analysis of Inconsistent Effects: A Time for Change

Cornell, John E.; Mulrow, Cynthia D.; Localio, Russell; Stack, Catharine B.; Meibohm, Anne R.; Güallar, Eliseo; Goodman, Steven N.

doi:10.7326/m13-2886

Cited by 373 publications

(305 citation statements)

References 26 publications

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“…Because of the heterogeneity among the studies in the formal expression of results (namely, albuminuria per 24 hours or albumin excretion rate), the between-regimen changes in UAE and ACR were used in the analyses after conversion to percentages when not already available. The pooled MD and 95% confidence interval (95% CI) were estimated using a random effect estimator on the basis of small sample adjustments (likelihood-based method) (18,19). Sensitivity analysis and estimate of heterogeneity were performed as previously described (17).…”

Section: Statistical Analysesmentioning

confidence: 99%

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

D’Elia¹,

Rossi²,

Cola³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Urinary albumin excretion and/or albumin to creatinine ratio are associated with CKD and higher risk of cardiovascular events. Several studies investigated the effect of reduced dietary sodium intake on urinary albumin excretion and/or albumin to creatinine ratio in adult patient populations, but the majority was inconclusive because of insufficient statistical power. A meta-analysis of the randomized, controlled trials available could overcome this problem and lead to more definitive conclusions.Design, setting, participants, & measurements A systematic search of the online databases available (from 1996 to October of 2014) was conducted of randomized, controlled trials that expressed urinary albumin excretion or albumin to creatinine ratio as the difference between the effects of two different sodium intake regimens. For each study, the mean difference and 95% confidence intervals were pooled using a random effect model. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.Results Eleven studies met the predefined inclusion criteria and provided 23 cohorts with 516 participants and 1-6 weeks of follow-up time. In the pooled analysis, an average reduction in sodium intake of 92 mmol/d was associated with a 32.1% (95% confidence interval, 244.3 to 218.8) reduction in urinary albumin excretion. The effect of sodium restriction was higher in the cohorts including patients on concomitant renin-angiotensin-aldosterone system-blocking therapy, in the studies with intervention lasting at least 2 weeks, and among participants with evidence of kidney damage. A greater reduction of urinary albumin excretion was associated with a higher decrease in BP during the intervention. The analysis of changes in albumin to creatinine ratio provided similar results.Conclusions This meta-analysis indicates that sodium intake reduction markedly reduces albumin excretion, more so during concomitant renin-angiotensin-aldosterone system-blocking therapy and among patients with kidney damage.

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Section: Statistical Analysesmentioning

confidence: 99%

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

D’Elia¹,

Rossi²,

Cola³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…The method of HartungKnapp-Sidik-Jonkman (HKSJ) [40,41] was employed. This method is recommended over the more common DerSimonian and Laird (DSL) method [42,43] for meta-analyses where only few studies are available (the DSL method was also calculated for comparison). Pooled effect sizes were reported as weighted mean differences (MD) between treatments in the original units when possible, with a 95% confidence interval (CI).…”

Section: Data Synthesismentioning

confidence: 99%

“…Language bias may also have been present as all search terms were in English, although indexed terms were used which may have minimised potential language bias. Finally, the HKSJ estimation method, though chosen because it provides a more conservative estimate than more common approaches, may overestimate uncertainty with so few included studies [42].…”

Section: Strengths and Limitations Of This Reviewmentioning

confidence: 99%

Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis (Preprint)

Simmich¹,

Deacon²,

Russell³

2018

Preprint

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“…However, lack of confidence and the need to repeat the assessment of the RB leads to questions about the possibility of the review being redone or used in the current review. [1][2][3][4]11,12,[14][15][16] Minimum Criteria for the Definition of a Good Systematic Review 8,9…”

Section: Assessment Of the Risk Of Biasmentioning

confidence: 99%

Guidelines for Integration of Systematic Reviews using Primary Studies

Botelho

Oliveira

2016

Arq Bras Neurocir

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Objectives Due to the growing number of systematic reviews published and the need to update the existing revisions, the Agency for Healthcare Research and Quality (AHRQ) -Evidence-based Practice Centers (EPC) published in 2008 a preliminary guide to integrate primary data education to data from systematic reviews already published. This study is a translation effort of the American agency's guidelines to provide subsidies for revisions in our midst. Methods A study group with experts in systematic review was gathered to identify any methodological requirements that need clarification and guidance to revision developers that used existing reviews. In addition, they identified and consulted experienced researchers to provide guidance on conducting systematic reviews: Key informants (KI).Results No evidence was found in the literature for the driving advice based on the integration of existing systematic reviews and primary assays. Recommendations were based on expert opinion. Conclusion The literature lacks guidelines for integration of systematic reviews and primary studies. Palavras-chave► revisão sistemática ► pesquisa clínica ► estudos primários ResumoObjetivos Devido ao crescimento do número de revisões sistemáticas publicadas e a necessidade de atualização das revisões existentes, a Agency for Healthcare Research and Quality (AHRQ) -Evidence-based Practice Centers (EPC) -publicou em 2008 um guia preliminar para integrar os dados dos estudos primários aos dados das revisões sistemáticas já publicadas, no desenvolvimento de novas revisões sistemáticas. Este estudo é um esforço de tradução das orientações da agência americana, com o intuito de fornecer subsídios para as revisões em nosso meio. Métodos Um grupo de estudos com especialistas em revisão sistemática foi reunido para identificar as eventuais necessidades metodológicas que precisariam de

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Random-Effects Meta-analysis of Inconsistent Effects: A Time for Change

Cited by 373 publications

References 26 publications

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System–Inhibiting Treatment on Albuminuria

Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis (Preprint)

Guidelines for Integration of Systematic Reviews using Primary Studies

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