Mao, Michael A.

Background: The number of total hip arthroplasties (THA) performed across the world is growing rapidly. We performed this meta-analysis to evaluate the incidence of acute kidney injury (AKI) in patients undergoing THA. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until July 2018 to identify studies assessing the incidence of AKI (using standard AKI definitions of RIFLE, AKIN, and KDIGO classifications) in patients undergoing THA. We applied a random-effects model to estimate the incidence of AKI. The protocol for this meta-analysis is registered with PROSPERO (no. CRD42018101928). Results: Seventeen cohort studies with a total of 24,158 patients undergoing THA were enrolled. Overall, the pooled estimated incidence rates of AKI and severe AKI requiring dialysis following THA were 6.3% (95% CI: 3.8%–10.2%) and 0.5% (95% CI: 0.1%–2.3%). Subgroup analysis based on the countries by continent was performed and demonstrated the pooled estimated incidence of AKI following THA of 9.2% (95% CI: 5.6%–14.8%) in Asia, 8.1% (95% CI: 4.9%–13.2%) in Australia, 7.4% (95% CI: 3.2%–16.3%) in Europe, and 2.8% (95% CI: 1.2%–17.0%) in North America. Meta-regression of all included studies showed significant negative correlation between incidence of AKI following THA and study year (slope = −0.37, p <0.001). There was no publication bias as assessed by the funnel plot and Egger’s regression asymmetry test with p = 0.13 for the incidence of AKI in patients undergoing THA. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring dialysis in patients undergoing THA are 6.3% and 0.5%, respectively. There has been potential improvement in AKI incidence for patients undergoing THA over time.

AbstractBackgroundThis study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6‐year period in Thailand.MethodsT2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low‐density lipoprotein cholesterol (LDL‐C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment‐related complications included hospital admissions due to dysglycemia.ResultsA total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL‐C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001).ConclusionThere has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes.

ABSTRACTAimPrevious studies have suggested a higher incidence of urologic malignancies in end‐stage renal disease (ESRD) patients. However, incidence trends of urologic malignancies in ESRD patients remain unclear. The aims of the present study were: (i) to investigate the pooled incidence/incidence trends; and (ii) to assess the risk of urologic malignancies in ESRD patients.MethodsA literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through April 2017. Studies that reported incidence or odds ratios of urologic malignancies among ESRD patients were included. Pooled odds ratios (OR) and 95%CI were calculated using a random‐effect model. The protocol for this meta‐analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067687).ResultsNineteen observational studies with 1 931 073 ESRD patients were enrolled. The pooled estimated incidence of kidney cancer and urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) in ESRD patients were 0.3% (95%CI: 0.2–0.5%) and 0.5% (95%CI: 0.3–0.8%), respectively. Meta‐regression showed significant positive correlation between incidence of urologic malignancies in ESRD patients and year of study (slopes = +0.05 and +0.07, P < 0.001 for kidney cancer and urothelial cancers, respectively). Compared to non‐ESRD status, ESRD was significantly associated with both kidney cancer (pooled OR 6.04; 95% CI 4.70–7.77) and urothelial cancers (pooled OR 4.37; 95% CI 2.40–7.96).ConclusionOur study demonstrates a significant association between ESRD and urologic malignancies. The overall estimated incidence rates of kidney cancer and urothelial cancers are 0.4% and 0.5%, respectively. There is a significant positive correlation between the incidence of urologic malignancies and year of study.

AbstractObjectiveThe study's aims were (1) to investigate the prevalence and (2) to assess the risk of Helicobacter pylori (H. pylori) infection in kidney transplant recipients.MethodsA comprehensive literature search was performed from inception until September 2016. Studies that reported prevalence, relative risks, odd ratios, or hazard ratios of H. pylori among kidney transplant recipients were included. Pooled risk ratios and 95% CI were calculated using a random‐effect model.ResultsEleven observational studies with 2545 kidney transplant recipients were enrolled. Between year 1990 and 2000, the estimated prevalence of H. pylori among people with kidney transplant was 50% (95% CI: 31% to 68%), with a prevalence of 46% (95% CI: 23% to 70%) in high‐income countries and 55% (95% CI: 22% to 86%) in middle‐income countries, respectively. From year 2000 to 2016, the estimated prevalence of H. pylori among people with kidney transplant was 35% (95% CI: 26% to 45%), with a prevalence of 28% (95% CI: 19% to 37%) in high‐income countries and 45% (95% CI: 38% to 51%) in middle‐income countries. Data regarding prevalence of H. pylori infection in low‐income countries were limited. The pooled RR of H. pylori in kidney transplant recipients was 0.57 (95% CI: 0.33 to 1.00) when compared to people with non‐transplant.ConclusionsThere has been a decline in prevalence of H. pylori in kidney transplant recipients with the overall estimated prevalence of H. pylori in kidney transplant recipients of 35%, particularly in both high‐income and middle‐income countries. Also, our meta‐analysis demonstrates a potential decreased risk of H. pylori infection in kidney transplant recipients compared with non‐transplant populations.