PREDICTION OF ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN END STAGE RENAL DISEASE WITH CENTRAL HAEMODYNAMICS: A SYSTEMATIC REVIEW PROTOCOL
Authors: da Silva Guedes de Moura Bárbara Letícia , Batista Felipe Steinmacher , Rodrigues Ramajo Guilherme Luiz , Valente Gustavo Bueno , Scalon Estércio Rizzo João Vitor , Campos Maftoum Tarik Radi , Demarchi Izabel Galhardo , Yamada Sérgio Seiji , Passos Okawa Rogério Toshiro , Vieira Teixeira Jorge Juarez 
Published: July 2022

Background

Given the high rates of adverse events in End-stage renal disease (ESRD) patients and as the applications of central haemodynamics (central blood pressure, augmentation index, pulse wave velocity) in dialysis patients have not been fully clarified, we, therefore, will perform a systematic review of central haemodynamics as a predictor of total and cardiovascular mortality and morbidity in the ESRD population.

Methods

This protocol is reported according to the PRISMA-P guideline. The databases PubMed, EMBASE, LILACS, Web of Science, and Google Scholar system will be searched and double screening for prospective studies that assessed the prospective association of central haemodynamics parameters with at least one of the pre-specified outcomes in ESRD patients. Discrepancies will be resolved through consensus. A modified version of the Newcastle-Ottawa Quality Assessment Scale of cohort studies will be used. We intend to use the random-effects model, considering at least moderate heterogeneity between studies. If data allow, we will perform a sensitivity analysis to explore potential sources of between-study heterogeneity.

Discussion

This systematic review will summarize current evidence about central haemodynamics measures in the ESRD patients and clarify the incremental prognostic value of this diagnostic tool in these patients. Therefore, this systematic review will also be displayed important knowledge gaps in the current literature regarding the possible utility of central haemodynamics indices in ESRD patients.

Systematic review registration

This systematic review protocol was submitted to the PROSPERO international registry of systematic reviews (Registration number: CRD42022260824).

Strengths and limitations of this study

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The PROSPERO registry helps to promote and maintain transparency in the process and to assist in minimizing the risk of bias. Four databases and one additional grey literature source helps ensure more complete coverage of the topic. All the review phases will be peer-reviewed and will be validated by methodological and clinical experts.

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Central (aortic, carotid) pressures are pathophysiologically more relevant than peripheral pressures for the pathogenesis of cardiovascular (CV) disease. There is a cumulative increase in CVD during the transition from CKD to ESRD: as patients initiate dialysis, there are significant changes in blood pressure, volume status, and circulating solutes, all of which may contribute to increased risk of CVD. Studies did not further analyze the ability of central pressures and indices to predict future events in separated stages of CKD, especially in End-stage renal disease patients (ESRD) patients.

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This study has limitations. Because heterogeneity is quite common in these systematic reviews, there may be limited scope for meta-analysis. Possibly, the spectrum of patients in different research sites is the main factor, in most cases, but heterogeneity in associations between studies may be difficult to explain.

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This systematic review will evaluate the evidence related to the Central Haemodynamics (central blood pressure, augmentation index, pulse wave velocity) incremental prognostic value in ESRD patients, which may lower morbidity and mortality and influence its use as a prognostic marker for ESRD patients.