Jun 25, 2022
Version 3
Systematic review and meta-analysis of incidence and outcomes of hip and vertebral fractures hip fracture in patients with end-stage kidney disease V.3
- Yoshinosuke Shimamura1,
- Yasutaka Kuniyoshi2,
- Hiroshi Ueta3,
- Takamasa Miyauchi4,
- Mari Yamamoto5,
- Yasushi Tsujimoto6
- 1Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido;
- 2Department of Pediatrics, Tsugaruhoken Medical COOP Kensei Hospital, Hirosaki, Japan;
- 3Department of Anesthesiology and Critical Care, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan.;
- 4Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan.;
- 5Department of Rheumatology and Nephrology, Chubu Rosai Hospital, Nagoya, Japan.;
- 6Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Protocol Citation: Yoshinosuke Shimamura, Yasutaka Kuniyoshi, Hiroshi Ueta, Takamasa Miyauchi, Mari Yamamoto, Yasushi Tsujimoto 2022. Systematic review and meta-analysis of incidence and outcomes of hip and vertebral fractures hip fracture in patients with end-stage kidney disease. protocols.io https://dx.doi.org/10.17504/protocols.io.3byl4brjrvo5/v3Version created by Yoshinosuke Shimamura
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: In development
We are still developing and optimizing this protocol
Created: June 06, 2022
Last Modified: June 25, 2022
Protocol Integer ID: 63961
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Abstract
This is the protocol for a systematic review and meta-analysis to systematically and quantitatively evaluate the mortality rate and time-period mortality after hip fracture and spinal fracture in patients with ESKD treated with hemodialysis, peritoneal dialysis, or kidney transplantation.
Materials
References
- Alem AM, Sherrard DJ, Gillen DL, et al. Increased Risk of Hip Fracture among Patients with End-Stage Renal Disease. Vol 58.; 2000.
- Wakasugi M, Kazama JJ, Taniguchi M, et al. Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab. 2013;31(3):315-321. doi:10.1007/s00774-012-0411-z
- Tentori F, McCullough K, Kilpatrick RD, et al. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2014;85(1):166-173. doi:10.1038/ki.2013.279
- Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000;36(6):1115-1121. doi:10.1053/AJKD.2000.19812
- Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis. 2004;44(4):672-679. doi:10.1053/j.ajkd.2004.07.001
- Danese MD, Kim J, Doan Q V., Dylan M, Griffiths R, Chertow GM. PTH and the risks for hip, vertebral, and pelvic fractures among patients on dialysis. Am J Kidney Dis. 2006;47(1):149-156. doi:10.1053/j.ajkd.2005.09.024
- Nair SS, Mitani AA, Goldstein BA, Chertow GM, Lowenberg DW, Winkelmayer WC. Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States. Clin J Am Soc Nephrol. 2013;8(8):1336-1342. doi:10.2215/CJN.10901012
- Lin ZZ, Wang JJ, Chung CR, et al. Epidemiology and mortality of hip fracture among patients on dialysis: Taiwan National Cohort Study. Bone. 2014;64:235-239. doi:10.1016/j.bone.2014.04.017
- Lin JCF, Liang WM. Mortality and complications after hip fracture among elderly patients undergoing hemodialysis. BMC Nephrol. 2015;16(1). doi:10.1186/s12882-015-0099-0
- Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. BMJ. 2015;349(January):1-25. doi:10.1136/bmj.g7647
- Munn Z, MClinSc SM, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147-153. doi:10.1097/XEB.0000000000000054
- Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Heal Policy Manag. 2014;3(3):123-128. doi:10.15171/ijhpm.2014.71
- Inthout J, Ioannidis JPA, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6:10247. doi:10.1136/bmjopen-2015
- Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67(8):897-903. doi:10.1016/j.jclinepi.2014.03.003
- Simmonds M. Quantifying the risk of error when interpreting funnel plots. Syst Rev. 2015;4(1). doi:10.1186/s13643-015-0004-8
- Sterne JAC, Gavaghan D, Egger M. Publication and related bias in meta-analysis: Power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119-1129. doi:10.1016/S0895-4356(00)00242-0
Authors' Information
Authors' Information
Last update: June 24 2022.
Authors: Yoshinosuke Shimamura MD, MPH1, 2; Yasutaka Kuniyoshi MD, PhD2,3; Hiroshi Ueta MD, PhD2,4; Takamasa Miyauchi MD, PhD2,5; Mari Yamamoto MD2,6; Yasushi Tsujimoto MD, MPH2, 7.
1 Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan.
2 Scientific Review WorkshopS Peer Support Group (SRWS-PSG), Osaka, Japan.
3 Department of Pediatrics, Tsugaru Hoken Kensei Hospital, Hirosaki, Aomori, Japan.
4 Department of Anesthesiology and Critical Care, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan.
5 Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan.
6 Department of Rheumatology and Nephrology, Chubu Rosai Hospital, Nagoya, Japan.
7 Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Hyogo, Japan.
Corresponding author: Yoshinosuke Shimamura MD, MPH
Address: Department of Nephrology, Teine Keijinkai Medical Center, 1-40, 12 chome, 1 jyou, Maeda, Teine, Sapporo, Hokkaido, 0068555, Japan.
E-mail: yshimamura.tkh@gmail.com
Author contributions:
YS is the guarantor. YS, YK, HU, TM, MY, and YT drafted the manuscript.
All authors contributed to the development of the selection criteria, the risk of bias assessment strategy, and data extraction criteria. YS, YK, and YT developed the search strategy. YK and YT provided statistical expertise. All authors read, provided feedback, and approved the final manuscript.
Introduction
Introduction
Hip fracture is one of the major health problems in patients with end-stage kidney disease (ESKD) requiring renal replacement therapy, including hemodialysis, peritoneal dialysis, or kidney transplantation, because they have a higher risk for hip fracture than the general population 123. In addition, several studies have demonstrated that hip fracture had a high burden of morbidity and mortality, and costs in patients with ESKD 456. Along with the aging of the dialysis population, the increased risk of fractures may be explained by changes in phosphorus handling, vitamin D metabolism, and alternations in parathyroid hormone production and secretion associated with exacerbation of renal impairment 7.
Although prior studies have reported mortality rates after hip fracture in those with ESKD 789, the reported mortality rates vary across studies. Besides, a comprehensive and quantitative analysis of each finding in these studies has not been conducted.
Therefore, we aim to conduct a systematic review and meta-analysis to systematically and quantitatively evaluate the mortality rate and time-period mortality after hip fracture and spinal fracture in patients with ESKD treated with hemodialysis, peritoneal dialysis, or kidney transplantation.
Research Question
Research Question
What are the mortality rate, 1-year mortality, and 5-year mortality after hip fracture and spinal fracture in patients with ESKD treated with hemodialysis or peritoneal dialysis, or kidney transplant?
Methods
Methods
We followed the Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 10 for preparing this protocol.
Inclusion criteria of articles for the review
4.1.1. Types of included studies
We will include prospective and retrospective cohort studies, including cohorts from controlled trials, that describe outcomes after hip or spinal fracture in patients with ESKD treated with hemodialysis or peritoneal dialysis or kidney transplant. We will also include original reports such as case series in which all participants had mortality outcomes or cohort studies. We will not restrict publication date and status (full publication, conference abstract, and unpublished data).
We will exclude case reports with three cases or less, animal and laboratory studies, and literature reviews. We will also exclude not yet recruiting, recruiting, or withdrawn studies in Clinical.Trial.gov.
4.1.2. Study participants
Inclusion criteria:
We will include patients with ESKD treated with hemodialysis or peritoneal dialysis or kidney transplant, regardless of the etiology of chronic kidney disease, follow-up duration, and country of origin. We will include patients of any age, sex, and race.
Exclusion criteria:
None.
4.1.3. Intervention(s) or exposure(s)
Not applicable.
4.1.4. Comparator(s) or control(s)
Not applicable.
Type of outcomes
4.2.1. Primary outcomes
- Mortality rate, 1-year mortality, and 5-year mortality after hip fracture.
- Mortality rate, 1-year mortality, and 5-year mortality after spinal fracture.
Search methods
4.3.1. Electronic search
We will search Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, and EMBASE via ProQuest Dialog. See Appendix 1, 2, and 3 for the search strategies.
4.3.2. Other sources
For ongoing or unpublished trials, we will also search World Health Organization International Clinical Trials Platform Search Portal (ICTRP) and ClinicalTrials.gov, as shown in Appendix 4 and 5. We will also confirm paper references including the extracted studies. We will ask the authors of original studies for unpublished or additional data.
Data collection and analysis
4.4.1. Selection of the studies
Two independent authors will screen the titles and abstracts of studies identified using the search strategy against the inclusion and exclusion criteria. The full text of the potentially eligible studies will be obtained and independently assessed for eligibility by two authors. If we are not sure whether the studies meet the inclusion criteria because of the abstract only, we will contact the original authors of these studies. Any disagreements will be resolved by discussion, and if this fails, a third reviewer will act as an arbiter.
4.4.2. Data extraction and management
Two review authors will perform data extraction for the studies independently. The 1-year and 5-year mortality will be extracted, but the mortality less than 1 year will not be extracted. We will extract the data if studies report the mortality of more than 1 year and less than 5 years (e.g., 2-year mortality), but do not report either 1-year or 5-year mortality. In that case, the outcome data for less than 3 years will be included as 1-year mortality, and the data for 3 to 5 years will be included as 5-year mortality. We will perform a sensitivity analysis excluding the outcome data other than 1-year and 5-year mortality to confirm the robustness of the main results. Any disagreements will be resolved by discussion, and if this fails, a third reviewer will act as an arbiter. We will contact the original authors if necessary. We will use data extraction which was checked beforehand for 10 randomly selected studies.
Assessment of risk of bias in included studies
Two review authors will independently assess the risk of bias for each study using the Joanna Briggs Institute Prevalence Critical Appraisal Tool 1112. We will assess the following domains:
- Was the sample frame appropriate to address the target population?
- Were study participants sampled in an appropriate way?
- Was the sample size adequate?
- Were the study subjects and the setting described in detail?
- Was the data analysis conducted with sufficient coverage of the identified sample?
- Were valid methods used for the identification of the condition?
- Was the condition measured in a standard, reliable way for all participants?
- Was there appropriate statistical analysis?
- Was the response rate adequate, and if not, was the low response rate managed appropriately?
Any disagreements will be resolved by discussion, and if this fails, a third reviewer will act as an arbiter. In this study, the overall risk of bias will be calculated as the number of “Yes” responses for each domain divided by the total number of domains and expressed as a percentage. The overall risk of bias will be defined based on the calculated percentage as follows: <50%: high risk of bias; 50% to 80%: moderate risk of bias; >80%: low risk of bias).
Measures of treatment effects
Incidence rate and risk (incidence proportion) with 95% confidence intervals (CIs) and 95% prediction intervals. Incidence rate will be measured as the number of incident cases per measure of exposure and incidence proportion will be measured as the number of incident cases over a specified time frame. The statistical heterogeneity will be assessed using τ2 statistics, which provide a logit scale measure of between-study variance, represented in a more readily interpretable way by the 95% prediction intervals.
Handling of missing data
We will not complement the missing values.
Assessment of heterogeneity
We will evaluate the statistical heterogeneity by visual inspection of the forest plots and calculating the I2 statistic (I2 values of 0% to 40%: might not be important; 30% to 60%: may represent moderate heterogeneity; 50% to 90%: may represent substantial heterogeneity; 75% to 100%: considerable heterogeneity). If heterogeneity is detected (I2>50%), we will verify the possible causes. Cochrane Chi-square test (Q-test) will be performed to calculate I2 statistic, and P value less than 0.10 will be defined as statistically significant.
Assessment of reporting bias
We will search the clinical trial registry system (ClinicalTrial.gov and ICTRP) to identify completed but unpublished studies. We will assess the potential publication bias by visual inspection of the funnel plot. Egger test will also be performed. Funnel plots are likely to be inaccurate in meta-analyses of prevalence studies with low proportions of outcomes 14, we will not conduct the test and visual inspection if we find less than 20 studies 1516or studies that have similar sample sizes.
Meta-analysis
We will use a single-arm analysis. For categorical variables, the percentage, mean, and standard deviation were calculated. We will calculate pooled incidence rate and incident proportion of death in patients with ESKD after hip fracture as well as in those with ESKD after spinal fracture. The random-effects model (DerSimonian and Laired method) will be used for pooled estimates to consider the variance between and among the studies. We will conduct statistical analyses using the R software (R Development Core Team 2019), with packages meta version 4.15-0 and metaphor version 2.4-0.
Subgroup analysis
To evaluate the clinical heterogeneity of study participants, we will perform subgroup analyses for primary outcomes with sex (men versus. women), race (Black versus. non-Blacks), presence or absence of cardiovascular diseases [hypertension, coronary artery disease, congestive heart failure, cerebrovascular disease, peripheral vascular disease], presence or absence of diabetes mellitus, types of renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplant, and participants’ age category (Age ≥75 versus. Age <75), if possible.
Sensitivity analysis
We will perform a sensitivity analysis limited to population-based cohort studies that describe outcomes after hip or spinal fracture in patients with ESKD treated with hemodialysis or peritoneal dialysis or kidney transplant. We will also perform a sensitivity analysis excluding the outcome data other than 1-year and 5-year mortality to confirm the robustness of the main results.
Conflicts of interest
Conflicts of interest
None.
| #1 | [mh “Kidney Diseases”] | |
| #2 | [mh “Renal Replacement Therapy”] | |
| #3 | [mh “Renal Dialysis”] | |
| #4 | [mh “Peritoneal Dialysis”] | |
| #5 | [mh “Hemodiafiltration”] | |
| #6 | [mh “Hemodialysis, Home”] | |
| #7 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 | |
| #8 | ESRD:ti,ab | |
| #9 | “end stage renal disease”:ti,ab | |
| #10 | ESKD:ti,ab | |
| #11 | “end stage kidney disease”:ti,ab | |
| #12 | ESKF:ti,ab | |
| #13 | “end stage kidney failure”:ti,ab | |
| #14 | ESRF:ti,ab | |
| #15 | “end stage renal failure”:ti,ab | |
| #16 | CKD:ti,ab | |
| #17 | “chronic kidney disease”:ti,ab | |
| #18 | “chronic kidney failure”:ti,ab | |
| #19 | “renal transplantation”:ti,ab | |
| #20 | CAPD:ti,ab | |
| #21 | CCPD;ti,ab | |
| #22 | APD;ti,ab | |
| #23 | “hemodialysis”:ti,ab | |
| #24 | “haemodialysis”ti,ab | |
| #25 | “hemodiafiltration”:ti,ab | |
| #26 | “haemodiafiltration”:ti,ab | |
| #27 | #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 | |
| #28 | #7 OR #27 | |
| #29 | [mh “Femoral Fractures”] | |
| #30 | “femoral fracture”:ti,ab | |
| #31 | “femoral neck fracture”:ti,ab | |
| #32 | “hip fracture”:ti,ab | |
| #33 | #30 OR #31 OR #32 | |
| #34 | #29 OR #33 | |
| #35 | [mh “Spinal Fractures”] | |
| #36 | “vertebral fracture”:ti,ab | |
| #37 | “spine fracture”:ti,ab | |
| #38 | #36 OR #37 | |
| #39 | #35 OR #38 | |
| #40 | #34 OR #39 | |
| #41 | "incidence [MeSH: noexp]" OR [mh mortality] OR "follow up studies [MeSH: noexp]" OR prognos*:ti,ab,kw OR predict*:ti,ab,kw OR course*:ti,ab,kw | |
| #42 | #28 AND #40 AND #41 | |
| #43 | [mh “Animals”] NOT [mh “Humans”] | |
| #44 | #42 NOT #43 |
Appendix 1: CENTRAL search strategy
| #1 | Kidney Diseases [mh] | |
| #2 | Renal Replacement Therapy [mh] | |
| #3 | Renal Dialysis [mh] | |
| #4 | Peritoneal Dialysis [mh] | |
| #5 | Hemodiafiltration [mh] | |
| #6 | Hemodialysis, Home [mh] | |
| #7 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 | |
| #8 | ESRD [tiab] | |
| #9 | “End Stage Renal Disease” [tiab] | |
| #10 | ESKD [tiab] | |
| #11 | “End Stage Kidney Disease” [tiab] | |
| #12 | ESKF [tiab] | |
| #13 | “End Stage Kidney Failure” [tiab] | |
| #14 | ESRF [tiab] | |
| #15 | “End Stage Renal Failure” [tiab] | |
| #16 | CKD [tiab] | |
| #17 | “Chronic Kidney Disease” [tiab] | |
| #18 | “Chronic Kidney Failure” [tiab] | |
| #19 | “Renal Transplantation” [tiab] | |
| #20 | CAPD [tiab] | |
| #21 | CCPD [tiab] | |
| #22 | APD [tiab] | |
| #23 | “Hemodialysis” [tiab] | |
| #24 | “Haemodialysis” [tiab] | |
| #25 | “Hemodiafiltration” [tiab] | |
| #26 | “Haemodiafiltration” [tiab] | |
| #27 | #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 | |
| #28 | #7 OR #27 | |
| #29 | Femoral Fractures [mh] | |
| #30 | “Femoral Fracture” [tiab] | |
| #31 | “Femoral Neck Fracture” [tiab] | |
| #32 | “Fracture, Hip” [tiab] | |
| #33 | #30 OR #31 OR #32 | |
| #34 | #29 OR #33 | |
| #35 | Spinal Fractures [mh] | |
| #36 | “Vertebral Fracture” [tiab] | |
| #37 | #35 OR #36 | |
| #38 | #34 OR #37 | |
| #39 | Mortality [mh] | |
| #40 | “Mortalty” [tiab] | |
| #41 | #39 OR #40 | |
| #42 | Death [mh] | |
| #43 | “Death” [tiab] | |
| #44 | #42 OR #43 | |
| #45 | Survival [mh] | |
| #46 | “Survival” [tiab] | |
| #47 | #45 OR #46 | |
| #48 | Prognosis [mh] | |
| #49 | “Prognosis” [tiab] | |
| #50 | #48 OR #49 | |
| #51 | #41 OR #44 OR #47 OR #50 | |
| #52 | #28 AND #38 AND #51 |
Appendix 2: MEDLINE (via PubMed) search strategy
| S1 | EMB.EXACT.EXPLODE(“kidney diseases”) | |
| S2 | EMB.EXACT.EXPLODE(“renal replacement therapy”) | |
| S3 | EMB.EXACT.EXPLODE (“hemodialysis”) | |
| S4 | EMB.EXACT.EXPLODE (“peritoneal dialysis”) | |
| S5 | EMB.EXACT.EXPLODE (“hemodiafiltration”) | |
| S6 | EMB.EXACT.EXPLODE (“home dialysis”) | |
| S7 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 | |
| S8 | ab(ESRD) OR ti(ESRD) | |
| S9 | ab(end stage renal disease) OR ti(end stage renal disease) | |
| S10 | ab(ESKD) OR ti(ESKD) | |
| S11 | ab(end stage kidney disease) OR ti(end stage kidney disease) | |
| S12 | ab(ESKF) OR ti(ESKF) | |
| S13 | ab(end stage kidney failure) OR ti(end stage kidney failure) | |
| S14 | ab(ESRF) OR ti(ESRF) | |
| S15 | ab(end stage renal failure) OR ti(end stage renal failure) | |
| S16 | ab(CKD) OR ti(CKD) | |
| S17 | ab(chronic kidney disease) OR ti(chronic kidney disease) | |
| S18 | ab(chronic kidney failure) OR ti(chronic kidney failure) | |
| S19 | ab(renal transplantation) OR ti(renal transplantation) | |
| S20 | ab(CAPD) OR ti(CAPD) | |
| S21 | ab(CCPD) OR ti(CCPD) | |
| S22 | ab(APD) OR ti(APD) | |
| S23 | ab(hemodialysis) OR ti(hemodialysis) | |
| S24 | ab(haemodialysis) OR ti(haemodialysis) | |
| S25 | ab(hemofiltration) OR ti(hemofiltration) | |
| S26 | ab(haemodiafiltration) OR ti(haemodiafiltration) | |
| S27 | S8 OR s9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 | |
| S28 | S7 OR S27 | |
| S29 | EMB.EXACT.EXPLODE (“femur fractures”) | |
| S30 | ab(femoral fracture) OR ti(femoral fracture) | |
| S31 | ab(femoral neck fracture) OR ti(femoral neck fracture) | |
| S32 | ab(hip fracture) OR ti(hip fracture) | |
| S33 | S30 OR S31 OR S32 | |
| S34 | S29 OR S33 | |
| S35 | EMB.EXACT.EXPLODE (“spine fractures”) | |
| S36 | ab(vertebral fracture) OR ti(vertebral fracture) | |
| S37 | ab(spinal fracture) OR ti(spinal fracture) | |
| S38 | S36 OR S37 | |
| S39 | S35 OR S38 | |
| S40 | S34 OR S39 | |
| S41 | EMB.EXACT.EXPLODE (“mortality”) | |
| S42 | EMB.EXACT.EXPLODE (“survival”) | |
| S43 | EMB.EXACT.EXPLODE (“prognosis”) | |
| S44 | S41 OR S42 OR S43 | |
| S45 | ab(mortality) OR ti(mortality) | |
| S46 | ab(survival) OR ti(survival) | |
| S47 | ab(prognosis) OR ti(prognosis) | |
| S48 | S45 OR S46 OR S47 | |
| S49 | S44 OR S48 | |
| S50 | S28 AND S40 AND S49 | |
| S51 | EMB.EXACT (animal experiment) NOT (EMB.EXACT (human experiment) OR EMB.EXACT (human)) | |
| S52 | S50 NOT S51 |
Appendix 3: EMBASE search strategy (ProQuest Dialog)
| Conditions: “Kidney Diseases” OR “Renal Replacement Therapy” OR “Renal Dialysis” OR “Peritoneal Dialysis” OR “Hemodiafiltration” | |
| Intervention: “Femoral Fractures” OR “Spinal Fractures” | |
| Recruitment status is ALL. |
Appendix 4: ICTRP search strategy
| Condition or disease: (Kidney Diseases OR Renal Replacement Therapy OR Renal Dialysis OR Peritoneal Dialysis OR Hemodiafiltration) AND (Femoral Fractures OR Spinal Fractures) | |
| Intervention: Not applicable | |
| Other terms: Mortality OR Death OR Survival OR Prognosis |
Appendix 5: ClinicalTrial.gov search strategy