Background
Methods
Data sources
Inclusion criteria
Data extraction
Statistical analyses
Results
Study selection
Study | Region | Design | Patients (%male) | Age (years) | Detection methods | Prevalence of CVC | Comparison of CVC | Events number HR (95% CI) | Follow-up (years) | Ajustment for covariates | NOS |
---|---|---|---|---|---|---|---|---|---|---|---|
Takahashi 2013 [5] | Japan | Prospective study | HD 1290 (64.3) | 61 ± 13 | Echocardiography | 57.50% | No. of CVC vs. absence | All-cause death (335): 1.47 (1.05-2.08), one CVC:1.43 (1.02-2.00), two CVC: 2.16 (1.51-3.11); Cardiovascular death (156):2.09 (1.17-3.94), one CVC1.68 (1.01-2.83), two CVC:2.80 (1.63-4.81) | 10 | Age, diabetes, BMI, albumin, creatinine, CRP and LVEF | 8 |
Raggi 2011 [11] | USA | Prospective study | HD 144 (49.3) | 55.4 ± 14.6 | Echocardiography, EBCT | 57.60% | No. of CVC vs. absence | All-cause death (59); one CVC:1.06 (0.54- 2.08), two CVC:2.12 (1.12 - 4.01) | 5.6 | Age, race, gender, diabetes mellitus status, history of atherosclerotic coronary vascular disease and pulse pressure | 7 |
Wang 2003 [12] | China | Prospective study | PD 192 (51) | 60 ± 10 (CVC); 53 ± 13 (no CVC) | Echocardiography | 32.30% | Presence vs. absence | All-cause death (46):2.50 (1.32 to 4.76); Cardiovascular death (23):5.39 (2.16 to 3.48) | 1.49 | Age, male gender, dialysis vintage, diabetes and atherosclerotic | 7 |
Panuccio 2004 [6] | Italy | Prospective study | HD 202 (55.9) | 65.0 ± 10.6 (CVC); 57.1 ± 15.5 (no CVC) | Echocardiography | 23.27% | Presence vs. absence | All-cause death (96):1.20 (0.75-1.92); Cardiovascular death (66):1.48 (0.86-2.54) | 3.67 | Age, sex, diabetes, CRP, ADMA, and background CV complications | 7 |
Varma 2005 [13] | USA | Prospective study | HD 137 (54.7) | 63 ± 15 | Echocardiography | 47.40% | Presence vs. absence | All-cause death (59):2.48 (1.49-4.13) | 3.5 | Not provided | 5 |
Mohamed 2013 [14] | USA | Prospective study | 101 (67.3) | 57.7 ± 9.2 (CVC); 46.7 ± 12.9 (no CVC) | Echocardiography, MSCT | 35.64% | One CVC vs. absence | All-cause death (11): 1.37 (0.62-3.05) | 2.85 | Age, gender, and IL-6 | 7 |
Li 2016 [15] | China | Prospective study | HD 302 (53.6) | 60.9 ± 12.9 (CVC); 55.9 ± 15.8 (no CVC) | Echocardiography | 32.78% | Presence vs. absence | All-cause death (63):1.88 (1.11-3.19); Cardiovascular death (36): 3.47 (1.76-6.84) | 2 | Age, diabetes, beta- blocker, ACEI or ARB, pre-HD DBP, serum phosphorus, serum albumin, CRP, uric acid, LV systolic dysfunction, and history of CV events and HVC. | 8 |
Zhong 2011 [16] | China | Prospective study | HD 96 (57.3) | 61 ± 14 (CVC); 52 ± 8 (no CVC) | Echocardiography | 32.29% | Presence vs. absence | Cardiovascular death(12): 3.50 (2.23~ 5.52) | 1.46 | Age, gender, duration of dialysis, diabetes, atherosclerotic vascular disease, and CRP | 6 |
Wang 2014 [17] | China | Prospective study | PD 112 (61.6) | 71.57 ± 9.52 (CVC); 56.15 ± 15.28 (no CVC) | Echocardiography | Not provided | Presence vs. absence | All-cause death (26): 3.139 (1.181-8.345) | 4.18 | Age, diabetes, calcium, phosphorus, rGFR, CRP, and PA | 8 |
Chen 2016 [18] | China | Prospective study | HD 110 (58.2) | 55.2 ± 1.4 | Echocardiography | 25.50% | Presence vs. absence | All-cause death (25): 1.563 (0.637–3.836); Cardiovascular death (16): 3.80 (1.15-12.558) | 3.5 | Age, gender, albumin, AAC, and 25(OH)D | 7 |
All-cause and cardiovascular mortality
Subgroups | Number of studies | Number of patients | Pooled HR | 95% CI | Heterogeneity among studies |
---|---|---|---|---|---|
All-causemortality | |||||
Region | |||||
Asia | 5 | 2006 | 1.76 | 1.38–2.25 | P = 0.450;I2 = 0.0% |
Non-Asian region | 2 | 339 | 1.71 | 0.84–3.49 | P = 0.040;I2 = 76.3% |
Dialysis modality | |||||
Hemodialysis | 5 | 2041 | 1.62 | 1.30–2.00 | P = 0.301;I2 = 17.8% |
Peritoneal dialysis | 2 | 304 | 2.68 | 1.57–4.58 | P = 0.703;I2 = 0.0% |
Follow-up duration | |||||
≥ 2 years | 6 | 2153 | 1.67 | 1.35–2.05 | P = 0.255;I2 = 23.8% |
< 2 years | 1 | 192 | 2.50 | 1.32–4.76 | – |
Echocardiography | |||||
1 physician | 4 | 743 | 2.320 | 1.714–3.140 | P = 0.778;I2 = 0.0% |
2 physicians | 3 | 1602 | 1.386 | 1.064–1.805 | P = 0.762;I2 = 0.0% |
Number of CVC | |||||
1 | 3 | 1535 | 1.35 | 1.02–1.79 | P = 0.738;I2 = 0.0% |
2 | 2 | 1434 | 2.15 | 1.57–2.94 | P = 0.960;I2 = 0.0% |
Cardiovascular mortality | |||||
Region | |||||
Asia | 5 | 1990 | 3.26 | 2.43–4.36 | P = 0.492;I2 = 0.0% |
Non-Asian region | 1 | 202 | 1.48 | 0.86–2.54 | – |
Dialysis modality | |||||
Hemodialysis | 5 | 2000 | 2.57 | 1.96–3.36 | P = 0.117;I2 = 45.8% |
Peritoneal dialysis | 1 | 192 | 5.39 | 2.16–3.48 | – |
Follow-up duration | |||||
≥ 2 years | 4 | 1904 | 2.17 | 1.56–3.03 | P = 0.202;I2 = 35.0% |
< 2 years | 2 | 288 | 3.81 | 2.54–5.72 | P = 0.407;I2 = 0.0% |
Echocardiography | |||||
1 physician | 3 | 590 | 3.718 | 2.624–5.268 | P = 0.691;I2 = 0.0% |
2 physicians | 3 | 1602 | 1.890 | 1.256–2.845 | P = 0.333;I2 = 9.0% |
Number of CVC | |||||
1 | 1 | 1290 | 1.68 | 1.01–2.83 | – |
2 | 1 | 1290 | 2.80 | 1.63–4.81 | – |