Wijarnpreecha, Karn

ABSTRACTBackgroundComplications related to peritoneal dialysis (PD) in patients with autosomal‐dominant polycystic kidney disease (ADPKD), including intraperitoneal rupture of renal cyst, hernia, membrane failure and peritonitis, have been reported. However, long‐term clinical outcomes of ADPKD patients on PD remain unclear. We performed this meta‐analysis to assess the risks of death, technique failure and peritonitis in ADPKD patients on PD.MethodsA systematic review was conducted using MEDLINE, EMBASE and Cochrane databases from inception to October 2017 to identify studies that evaluated the outcomes of ADPKD patients on PD, including the risks of death, technique failure and peritonitis. Non‐ADPKD patients on PD were used as controls. Effect estimates from the individual study were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsTwelve cohort studies with a total of 14 673 patients on PD (931 ADPKD and 13 742 non‐ADPKD patients) were enrolled. Compared with non‐ADPKD status, ADPKD was associated with significantly decreased mortality risk with pooled odds ratio (OR) of 0.68 (95% confidence interval (CI), 0.53–0.86; I2 = 0). There were no associations of ADPKD with the risks of technique failure of PD and peritonitis with pooled OR of 0.93 (95% CI, 0.79–1.10; I2 = 0) and 0.88 (95% CI, 0.75–1.05; I2 = 0), respectively. We found no publication bias as assessed by Egger's regression asymmetry test, with P = 0.90, 0.28 and 0.60 for the risks of mortality, technique failure and peritonitis in ADPKD patients on PD, respectively.ConclusionCompared with non‐ADPKD patients on PD, our study demonstrates that ADPKD patients on PD have 0.68‐fold decreased mortality risk. There are no associations of ADPKD status with the risks of technique failure or peritonitis.

Background/ObjectivesA negative association between cigarette smoking and celiac disease has been observed but results were inconsistent across the published studies. A meta‐analysis was conducted with the aim to identify all studies that investigated this association and to summarize the results of those studies.MethodsA comprehensive literature review was conducted utilizing MEDLINE and Embase databases through March 2018 to identify all cohort studies and case‐control studies that compared the risk of celiac disease among current and/or former smokers versus never‐smokers. Effect estimates from each study were extracted and combined together using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsA total of seven studies with 307,924 participants fulfilled the eligibility criteria and were included in the meta‐analysis. The pooled analysis found a significantly decreased risk of celiac disease among current smokers compared with never‐smokers with the pooled odds ratio (OR) of 0.52 (95% confidence interval (CI), 0.32–0.84; I2 86%). However, the risk of celiac disease among former smokers was not significantly different from never‐smokers with the pooled OR of 1.10 (95% CI, 0.76–1.60; I2 of 73%).ConclusionsA significantly decreased risk of celiac disease among current smokers compared with never‐smokers was demonstrated in this meta‐analysis.

Background/objectives The relationship between nonalcoholic fatty liver disease (NAFLD) and albuminuria has been shown in many epidemiologic studies, although the results were inconsistent. This meta-analysis was conducted to summarize all available data and to estimate the risk of albuminuria among patients with NAFLD. Methods Comprehensive literature review was conducted utilizing Medline and Embase database through January 2018 to identify studies that compared the risk of albuminuria among patients with NAFLD versus those without NAFLD. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results Nineteen studies (17 cross-sectional studies and two cohort studies) with 24 804 participants fulfilled the eligibility criteria and were included in this meta-analysis. The risk of albuminuria among patients with NAFLD was significantly higher than those without NAFLD with the pooled odds ratio (OR) of 1.67 [95% confidence interval (CI): 1.32–2.11]. Subgroup analysis demonstrated the significantly increased risk of albuminuria among patients with NAFLD without diabetes with pooled OR of 2.25 (95% CI: 1.65–3.06). However, we found no significant association between albuminuria and NAFLD among diabetic patients [pooled OR 1.28 (95% CI: 0.94–1.75)]. Conclusion A significantly increased risk of albuminuria among patients with NAFLD was observed in this meta-analysis. Physicians should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria especially in patients with NAFLD.

BACKGROUND: The possible relationship between obesity and the risk of colonic diverticulosis has been suggested by recent epidemiologic studies, although the results were inconsistent. OBJECTIVE: This systematic review and meta-analysis was conducted to summarize all of the available data. DATA SOURCES: A comprehensive literature review was conducted using the MEDLINE and EMBASE databases through January 2017. STUDY SELECTION: Studies that compared the risk of colonic diverticulosis among subjects with obesity versus those without obesity were included. MAIN OUTCOME MEASURES: Effect estimates from each study were extracted and combined together using a random-effect, generic inverse variance method. RESULTS: Of 2989 potentially eligible articles, 10 studies (9 cross-sectional studies and 1 prospective cohort study) with 53,520 participants met the eligibility criteria and were included in the meta-analysis. The risk of colonic diverticulosis in obese subjects was significantly higher than in those without obesity, with a pooled OR of 1.41 (95% CI, 1.20–1.65). The statistical heterogeneity was high, with an I2 of 75%. LIMITATIONS: High statistical heterogeneity and publication bias in favor of positive studies may have been present in this meta-analysis. CONCLUSIONS: A significant association between colonic diverticulosis and obesity was shown in this study. However, additional studies are still required to determine the causality. See Video Abstract at http://links.lww.com/DCR/A500.

Background/ObjectivesStudies have suggested that smokers may have a lower risk of primary sclerosing cholangitis (PSC) although the results have been inconsistent. This systematic review and meta‐analysis was conducted to summarize all available data to better characterize this association.MethodsA comprehensive literature review was conducted using Medline and Embase databases through January 2018 to identify all studies that compared the risk of PSC among current/former smokers versus nonsmokers. Effect estimates from each study were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird.ResultsSeven case‐control studies with 2,307,393 participants met the eligibility criteria and were included in the meta‐analysis. The risk of PSC among current smokers and former smokers was significantly lower than nonsmokers with the pooled odds ratio of 0.31 (95% CI, 0.18–0.53) and 0.52 (95% CI, 0.44–0.61), respectively. The risk remained significantly lower among current smokers and former smokers compared with nonsmokers even when only patients with PSC without inflammatory bowel disease were included.ConclusionsA significantly decreased risk of PSC among current and former smokers was demonstrated in this study.

AbstractAimsClostridium difficile infection (CDI) is a major concern for public health worldwide. Interestingly, the risk of poor clinical outcomes of CDI in patients with nasogastric tube (NGT) insertion is still controversial. The aim of this study was to assess the outcomes of CDI in patients with NGT insertion.MethodsA literature search was performed using MEDLINE, EMBASE, and The Cochrane Database of Systematic Reviews from inception through November 2017. Studies that reported relative risks, odds ratios, or hazard ratios comparing the clinical outcome of CDI in patients with NGT versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method.ResultsEight observational studies were included in our analysis to assess the association between NGT insertion and risk of poor outcome of CDI. The pooled RR of severe or complicated clinical outcomes of CDI in patients with NGT insertion was 1.81 (95% CI: 1.17 to 2.81).ConclusionsThis study demonstrated a statistically significant association between NGT insertion and risk of poor outcomes of CDI. This finding may impact clinical management and primary prevention of CDI. Avoidance of unnecessary NGT uses would improve the clinical outcomes of CDI.

Abstract Background/objectives Hepatitis C virus (HCV) infection is one of the most common causes of chronic liver disease. Several epidemiologic studies have suggested that patients with HCV infection might have a higher risk of osteoporotic fracture. However, the data are inconclusive. This systematic review and meta‐analysis was conducted with the aims to summarize all available evidence. Methods A literature search was performed using MEDLINE and EMBASE database from inception to June 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of osteoporotic fracture among HCV‐infected patients versus subjects without HCV infection were included. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method. Results Three studies with 362,285 participants met our eligibility criteria and were included in analysis. We found a significantly higher risk of osteoporotic fracture among patients with HCV infection with RR of 1.53 (95% CI 1.09 to 2.14). Conclusions Our study demonstrated an increased risk of osteoporotic fracture among HCV‐infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.

Background/objective Recent epidemiologic studies have suggested that patients with celiac disease might be at an increased risk of schizophrenia. However, the data on this risk remain inconclusive. This meta-analysis was conducted with the aim to summarize all available evidence. Methods A literature search was carried out using MEDLINE and Embase database from inception to June 2017. Studies that compared the risk of schizophrenia among patients with celiac disease versus individuals without celiac disease were included. Pooled odds ratio and 95% confidence interval were calculated using a random-effect, generic inverse-variance method. Results Of the 284 retrieved studies, four met our eligibility criteria and were included in the analysis. We found a higher risk of schizophrenia among patients with celiac disease compared with individuals without celiac disease with the pooled odds ratio of 2.03 (95% confidence interval: 1.45–2.86). The statistical heterogeneity of this study was insignificant (I 2=0%). Conclusion This systematic review and meta-analysis found a significantly higher risk of schizophrenia among patients with celiac disease.