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AimKidney transplant recipients are at high risk of fracture due to many factors such as nutritional status, hyperparathyroidism, acidosis and steroid administration. The current meta‐analysis aimed to comprehensively analyse the incidence and risk factors of fracture in kidney transplant recipients.MethodsA systematic search on Embase, Web of Science, PubMed and Cochrane Library until November 2023 was performed. RStudio software was used to analyse data.ResultsTwenty‐eight eligible studies containing 310 530 kidney transplant recipients were included in the analysis. The pooled incidence of fracture was 10% (95% confidence interval [CI]: 7%–13%) generally. When divided by regions, it was further observed that the pooled incidence of fracture was 13% (95% CI: 9%–17%) in Europe, 11% (95% CI: 6%–16%) in North America, 7% (95% CI: 3%–11%) in Asia. Regarding the risk factors, pooled analysis revealed that age of recipient (hazard ratio [HR] = 1.50, 95% CI: 1.17–1.91), female sex (HR = 1.45, 95% CI: 1.36–1.53), pretransplantation diabetes (HR = 1.76, 95% CI: 1.58–1.97), pretransplantation fracture history (HR = 2.28, 95% CI: 1.86–2.78), dialysis duration (HR = 1.09, 95% CI: 1.01–1.17) and deceased donor (HR = 1.21, 95% CI: 1.05–1.39) related to higher risk of fracture. The general quality of included studies was acceptable, and no publication bias existed except for the analysis between age of recipient and fracture incidence; further trim and fill method indicated age of recipient showed a correlation trend with the fracture incidence without the statistical significance.ConclusionThe pooled incidence of fracture reaches 10% in kidney transplant recipients, which relates to age of recipient, female sex, pretransplantation diabetes or fracture history, dialysis duration and decease donor.image
AimKidney transplant recipients are at high risk of fracture due to many factors such as nutritional status, hyperparathyroidism, acidosis and steroid administration. The current meta‐analysis aimed to comprehensively analyse the incidence and risk factors of fracture in kidney transplant recipients.MethodsA systematic search on Embase, Web of Science, PubMed and Cochrane Library until November 2023 was performed. RStudio software was used to analyse data.ResultsTwenty‐eight eligible studies containing 310 530 kidney transplant recipients were included in the analysis. The pooled incidence of fracture was 10% (95% confidence interval [CI]: 7%–13%) generally. When divided by regions, it was further observed that the pooled incidence of fracture was 13% (95% CI: 9%–17%) in Europe, 11% (95% CI: 6%–16%) in North America, 7% (95% CI: 3%–11%) in Asia. Regarding the risk factors, pooled analysis revealed that age of recipient (hazard ratio [HR] = 1.50, 95% CI: 1.17–1.91), female sex (HR = 1.45, 95% CI: 1.36–1.53), pretransplantation diabetes (HR = 1.76, 95% CI: 1.58–1.97), pretransplantation fracture history (HR = 2.28, 95% CI: 1.86–2.78), dialysis duration (HR = 1.09, 95% CI: 1.01–1.17) and deceased donor (HR = 1.21, 95% CI: 1.05–1.39) related to higher risk of fracture. The general quality of included studies was acceptable, and no publication bias existed except for the analysis between age of recipient and fracture incidence; further trim and fill method indicated age of recipient showed a correlation trend with the fracture incidence without the statistical significance.ConclusionThe pooled incidence of fracture reaches 10% in kidney transplant recipients, which relates to age of recipient, female sex, pretransplantation diabetes or fracture history, dialysis duration and decease donor.image
ObjectiveThe objectives of this scoping review were to provide an overview of existing guidelines for the development and validation of patient-reported outcome measures (PROMs), review them for comprehensiveness and clarity and provide recommendations for their use based on the goals of the instrument developers.DesignScoping review.MethodsA literature search was performed in PubMed, Scopus, PsycInfo and Google Scholar up to 2 June 2023 to identify guidelines for the development and validation of PROMs. Screening of records and reports as well as data extraction were performed by two reviewers. To assess the comprehensiveness of the included guidelines, a mapping synthesis was performed and steps to develop and validate a measurement instrument outlined in the included guidelines were mapped to an a priori framework including 20 steps, which was based on the guideline by de Vetet al.ResultsA total of 40 guidelines were included. Statistical advice (at least partially) was provided in 98% of the guidelines (39/40) and 88% (35/40) of the guidelines included examples for steps required to develop and validate PROMs. However, 78% (31/40) of the guidelines were not comprehensive and two essential steps in PROM development (‘consideration and elaboration of the measurement model’ and ‘responsiveness’) were not included in 80% and 72% of the guidelines, respectively. Three guidelines included all 20 steps and six included almost all steps (≥90% of steps) for developing and validating a PROM.DiscussionMost guidelines on PROM development and validation do not appear to be comprehensive, and some crucial steps are missing in most guidelines. Nevertheless, for some purposes of PROMs, many guidelines provide helpful advice and support.ConclusionAt least 15 guidelines may be recommended, including three comprehensive guidelines that can be recommended for the development and validation of PROMs for most purposes (eg, to discriminate between subjects with a particular condition and subjects without that condition, to evaluate the effects of treatments (between a pre and post time-points) or to evaluate a status quo).
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