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Meta-Analysis
. 2016 Jul 26;11(7):e0159963.
doi: 10.1371/journal.pone.0159963. eCollection 2016.

A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis

Susan K Morton  1 , Alexander J Rodríguez  1   2 , Dylan R Morris  1 , Abhishta P Bhandari  1 , Joseph V Moxon  1 , Jonathan Golledge  1   3
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis

Susan K Morton et al. PLoS One. .

Abstract

Background: Arteriovenous fistula (AVF) failure is a significant cause of morbidity and expense in patients on maintenance haemodialysis (HD). Circulating biomarkers could be valuable in detecting patients at risk of AVF failure and may identify targets to improve AVF outcome. Currently there is little consensus on the relationship between circulating biomarkers and AVF failure. The aim of this systematic review was to identify circulating biomarkers associated with AVF failure.

Methods: Studies evaluating the association between circulating biomarkers and the presence or risk of AVF failure were systematically identified from the MEDLINE, EMBASE and Cochrane Library databases. No restrictions on the type of study were imposed. Concentrations of circulating biomarkers of routine HD patients with and without AVF failure were recorded and meta-analyses were performed on biomarkers that were assessed in three or more studies with a composite population of at least 100 participants. Biomarker concentrations were synthesized into inverse-variance random-effects models to calculate standardized mean differences (SMD) and 95% confidence intervals (CI).

Results: Thirteen studies comprising a combined population of 1512 participants were included after screening 2835 unique abstracts. These studies collectively investigated 48 biomarkers, predominantly circulating molecules which were assessed as part of routine clinical care. Meta-analysis was performed on twelve eligible biomarkers. No significant association between any of the assessed biomarkers and AVF failure was observed.

Conclusion: This paper is the first systematic review of biomarkers associated with AVF failure. Our results suggest that blood markers currently assessed do not identify an at-risk AVF. Further, rigorously designed studies assessing biological plausible biomarkers are needed to clarify whether assessment of circulating markers can be of any clinical value. PROSPERO registration number CRD42016033845.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA study selection flow chart.
Fig 2
Fig 2. Circulating levels of albumin or CRP are not significantly associated with either AVF stenosis or AVF thrombosis in HD patients.
Forest plot of meta-analysis data showing the association between circulating albumin with AVF (a) stenosis or (b) thrombosis; and circulating CRP with AVF (c) stenosis or (d) thrombosis.
See this image and copyright information in PMC

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