Original InvestigationDialysisVascular Access for Intensive Maintenance Hemodialysis: A Systematic Review for a Canadian Society of Nephrology Clinical Practice Guideline
Section snippets
Protocol and Registration
Our review adhered to prespecified protocols registered with the PROSPERO International Prospective Register of Systematic Reviews (registration numbers: CRD42012001966 and CRD42012001967).
Types of Studies
We included clinical trials, cohort studies, case series, and case reports. We excluded opinion pieces, editorials, narrative reviews, and other publication types that did not include original data.
Types of Participants
We included studies describing adult (aged >18 years at the initiation of dialysis therapy) patients receiving
Study Selection
Study selection details and reasons for exclusion are presented in Fig 1, with further details in Table S1. We screened 3,127 titles and abstracts and 951 full-text articles and identified a total of 36 relevant full-text citations in the first-stage screen, as well as 4 systematic reviews that were hand searched for additional references. The second-stage (grey literature, bibliographic, and targeted PubMed) search yielded 39 additional studies. A total of 40 studies were excluded, leaving 23,
Discussion
To date, practices for intensive hemodialysis provision have evolved primarily from those used for patients receiving conventional hemodialysis. In this review, we identify a number of differences in vascular access–related outcomes across the range of specified comparisons. Collectively, these observations can inform the development of dedicated clinical practice guidelines for intensive hemodialysis, but also serve to identify many areas of uncertainty and priorities for future research.
Acknowledgements
Support: This study was supported with a grant from the Canadian Society of Nephrology (CSN). The CSN grant review committee made a number of suggestions, including the use of GRADE for the actual Clinical Practice Guidelines. Dr Brenda Hemmelgarn for the CSN grant review committee also provided mentorship throughout the project. This research also was funded in part by The Canadian Institutes of Health Research (Meeting Planning and Dissemination grant FRN #106165).
Financial Disclosure: The
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R.A.M., D.Z., and G.E.N. contributed equally to this work.