Shear Wave Elastography in the Evaluation of Renal Parenchymal Stiffness in Patients With Chronic Kidney Disease: A Meta-Analysis

Abstract

Background: Chronic kidney disease (CKD) is a progressive loss of renal function, mainly due to hypertension, diabetes, and primary kidney disease. The histopathological findings are that of glomerulosclerosis, tubulointerstitial fibrosis and loss of renal parenchyma characterized. Therefrom, CKD can lead to higher morbidity and mortality. Patients with CKD have multiple risk factors, and the prevention work is complicated and arduous. Therefore, it is important to quantify the severity of CKD. The aim of this study is to investigate the value of shear wave elastography (SWE) in the evaluating renal parenchymal stiffness in patients with CKD.

Methods: We carried out the systematic search of databases for publications in PubMed, Embase and Cochrane Library on SWE evaluating renal fibrosis in patients with CKD. The Endnote X9, STATA 16, Review Manager 5.3 and other software were used to sort out documents, extract, integrate and analyze data.

Results: The outcomes were utilized to appraise the diagnostic accuracy of SWE and diagnose the CKD with renal fibrosis. A total of 405 patients were enrolled and their data analysis results were as follows: summary of sensitivity (S-SEN) 84% (95% confidence interval (CI): 80-87%); specificity (S-SPE) 80% (95% CI: 76-84%); summary of DLR (digital light radiography) positive (DLR-P) 4.29 (95% CI: 3.43 - 5.37); and DLR negative (DLR-N) 0.20 (95% CI: 0.16 - 0.25). The corresponding areas under the curves of diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were 21.50 (95% CI: 14.69 - 31.46) and 89% (95% CI: 86-92%), respectively.

Conclusions: SWE is highly accurate and has clinical significance for evaluating renal fibrosis, especially when the shear modulus value is used as the threshold.

Keywords: Chronic kidney disease; Meta-analysis; Shear wave elastography.

Figure 1

Relationship or mechanisms between renal parenchyma stiffness, fibrosis, impaired renal function, and mortality. CKD: chronic kidney disease; GFR: glomerular filtration rate.

Figure 2

Screening processes of document and results.

Figure 3

Quality assessment of the studies according to QUADAS-2. QUADAS: Quality Assessment of Diagnostic Accuracy Studies.

Figure 4

The Forest plots showing diagnostic performance estimates (sensitivity and specificity) of CKD fibrosis. CKD: chronic kidney disease; CI: confidence interval.

Figure 5

The Forest plots demonstrating the study specificity of SWE on the right y axis in the evaluation of CKD fibrosis. CKD: chronic kidney disease; SWE: shear wave elastography; CI: confidence interval; DLR: digital light radiography.

Figure 6

The Forest map plot designed to demonstrate study-specific CKD of SWE on the right y axis in assessment. CKD: chronic kidney disease; SWE: shear wave elastography; CI: confidence interval.

Figure 7

The SROC curve: midas tp fp fn tn, es (x) plot SROC2 graph. SROC: summary receiver operating characteristic curve; LR: likelihood ratio.

Figure 8

The Fagan’s nomogram for SWE illustrating post-test probability with a fixed pre-test probability of 20% for CKD. CKD: chronic kidney disease; SWE: shear wave elastography; SEN: sensitivity; SPE: specificity.

Figure 9

The Deeks funnel plot is a bias-odd detection of the published results, all distributed on both sides of the regression lines, indicating that no significant deviations were found.