Create a systematic review research paper. For the question “Does at home peritoneal dialysis improve patient outcomes, when compared to facility hemodialysis in patients with end stage renal disease”.
Population and their problem: Adults with end stage renal disease
Intervention or issue/exposure: At home peritoneal dialysis
Comparative intervention: Facility hemodialysis
Outcomes or themes: Improved patient outcome
Timeframe: n/a
1) Use PubMed database, pick only 10 articles.
2) Needs to be a primary source. Not another systematic review.
3) Abstract, Introduction, Methods, Results, flow diagram, results table, discussion, and any limitations.
4) Research Flow diagram and results template included, check downloads.
Method section should include: Start off by stating you searched the literature published in English in PubMed and list the last date of search. With no restrictions on how long ago a study was published. List inclusion and exclusion criteria providing explanation and justifications as needed. List the key words and describe search.
Results section: should start off by stating. The search of PubMed provided a total of [#] articles. After removing [#] duplicates, the titles and abstracts of [#]articles were screened. Of these, [#] studies were excluded because it appeared that these articles did not meet the inclusion criteria [cannot answer the research question]. The full-text of [#]articles were searched. [Give #s and reasons for exclusions of full-text articles. For example, the full text of # articles were not available for free. # articles could not be feasibly translated into English.] [#] studies met the inclusion criteria and were included in the systematic review(citations in APA format). An additional [#] studies that met the criteria for inclusion were identified by checking the references of the eligible studies(citation of articles found in APA format). Provide a flow diagram base off the 10 articles. Flow diagram template include in down loads.
Include table with results for each article that met the criteria for inclusion. There is a table template include in downloads.
2nd paragraph describes flow diagram. Add a last sentence in the first paragraph which summarizes the results, making sure to answer your PICOT question.
1) The next paragraph synthesizes the level of evidence of the studies that are included (articles at the bottom of flow diagram).a. How many were level I, how many were level II, and how many were level III? I) Answer your PICOT question as it relates to level of evidence.
2) The next paragraph synthesizes the “P” and the “C” (if applicable) across your studies. Do the same for all the items in this column of your table. b. Answer your PICOT question as it pertains to the “P” or “C”.
3) The next paragraph synthesizes the “I” across your studies. Answer your PICOT question as it pertains to “I”.
4) The next paragraph synthesizes the “O” across your studies. Answer your PICOT question as it pertains to “O”
5) The next paragraph synthesizes the statistics across your studies. Answer your PICOT question as it pertains to the statistics.
6) The next paragraph synthesizes the adverse events (common with experimental designs) or attrition (common with longitudinal designs) across your studies. Answer your PICOT question as it pertains to the adverse events or attrition. Here is an example:
7) The next paragraph synthesizes the quality of the articles across the studies. Answer your PICOT question as it pertains to quality.
8) The next paragraph synthesizes the theory/conceptual models across your studies. Answer your PICOT question as it pertains to theory/conceptual models.
Discussion Section:
1 Reiterate the Research Problem/State the Major Findings
2. Explain the Meaning of the Findings and Why They are Important.
3. Relate the Findings to Similar Studies
4 Consider Alternative Explanations of the Findings
5 Acknowledge the Study’s Limitations
6. Make Suggestions for Further Research
A Systematic Review Research Paper: Does at Home Peritoneal Dialysis Improve Patient Outcomes, When Compared to Facility Hemodialysis in Patients with End Stage Renal Disease (ESRD)?
Chronic kidney disease (CKD) is deterioration in kidney function that is progressive and manifested by a reduction in the glomerular filtration rate or GFR. It is staged in five steps that are successive and depending on remaining kidney function. The first stage represents just mild kidney damage while the last and fifth stage is complete irreversible kidney damage. According to the American Kidney fund (2021), it is the estimated glomerular filtration rate (eGFR) that is clinically used to determine kidney function and the stage of kidney disease. The calculation of the eGFR is made with reference to the total serum creatinine levels in the body. This does not however mean that absolute values of serum creatinine can be used to determine the level of kidney failure. According to McCance and Huether (2019) and Jameson et al. (2018), the reason for this is that the relationship between the eGFR and serum creatinine is not linear. Factors such as age, gender, race/ ethnicity, as well as body weight do not affect the eGFR. However, these same factors directly determine what a person’s serum creatinine will be. An eGFR value of >90 mL/min/1.73 m2 is the normal eGFR value for a healthy person who does not have kidney disease. However, even without kidney disease, the eGFR is known to progressively decline as one ages. This simply means that kidney function declines with age. When a patient with kidney disease is diagnosed early through screening, it is usually possible for the nephrologist to slow down the progression to end-stage kidney disease (ESKD). This is of particular importance to patients who are hypertensive and suffer from diabetes, as it is known that one of the inevitable complications for these conditions is kidney failure. When the deterioration in kidney function as determined by the eGFR reaches stage five, however; the kidneys will have irreversibly failed. Kidney function at this stage is usually just 15% or less (National kidney foundation, 2021). That is why stage five of chronic kidney disease is referred to as end-stage kidney disease. Nothing can be done to revive the kidneys at this stage. The only remedy lies in renal replacement therapy or RRT. At the moment, this is comprised of three evidence-based interventions. They are:
- Hemodialysis (HD)
- Peritoneal dialysis (PD), and
- Kidney transplantation.
All the above three are viable interventions for ESKD. However, the practicality of kidney transplantation cannot be guaranteed because of the paucity of organs for transplantation. That leaves PD and HD as the only two practical day-to-day solutions for ESKD. The purpose of this paper is to systematically review ten primary studies that compare the efficacy of home PD and facility HD for patients with ESKD. Systematic Review Research Paper Example
Methods
The literature search was performed in the PubMed research database, with guidance from the PICOT question that had been formulated to give direction to the clinical inquiry process. The objective was to find peer-reviewed scholarly evidence that supports the efficacy of either home PD or facility HD in those patients that are suffering from ESKD. The PICOT question had stated that “In patients with end stage renal disease or ESRD (P), does at-home peritoneal dialysis or PD (I) compared to facility hemodialysis (C) improve patient outcomes (O)?” All the studies searched were in the English language and the last date of search was 03/02/2021. Search terms included “peritoneal dialysis,” “hemodialysis,” “better patient outcomes,” “end-stage-renal disease,” “Chronic kidney disease,” and “better patient outcomes.” These were combined using the Boolean operators “AND” and “OR”. Filters applied to narrow the search included the type of study. For this, systematic reviews and meta-analyses were excluded, even though they carry the highest level of evidence on the pyramid of evidence. There was no filter applied on the date of publication and all studies were included in the search. The inclusion criteria were as follows:
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- The studies had to be primary studies
- They must be comparing home peritoneal dialysis and facility hemodialysis; or facility hemodialysis and home hemodialysis
- The studies had to be quantitative in nature
The justification for this is that primary studies are more reliable as they provide new information that is not filtered. In terms of evidentiary value, these are the studies that in reality add to evidence-based practice or EBP knowledge. Also, the two main interventions that are opposed in the PICOT statement must be addressed by the studies for them to be acceptable. It will not be of much help if the article examined one intervention alone. The clinical inquiry is about determining the best EBP intervention between PD and HD. Lastly but not least, the studies are required to be quantitative in nature because the decision as to which of the two interventions is evidence-based needs to be backed up by numerical data.
The exclusion criteria included were as follows:
- Systematic reviews and meta-analyses
- Non-experimental qualitative studies
- Studies that include renal transplantation as an alternative intervention or RRT
The rationale or justification for the above exclusion criteria is that systematic reviews and meta-analyses are filtered studies that are not primary in origin. Qualitative non-experimental studies do not have the benefit of the use of nonparametric inferential statistical tools that help in drawing clinical inferences. Lastly but not least, studies that include assessment of renal transplantation as RRT will confound the findings concerning the efficacy of the two primary RRT options that are PD and HD.
Results
The search of PubMed yielded a total of 8,262 results or articles. After the removal of 3,603 duplicate studies, the titles and abstracts of 4,659 were subjected to screening. Out of these articles that were screened, 3,014 articles were excluded for not meeting the inclusion criteria. Then the full-texts of the remaining 1,645 articles were searched. A total of 802 articles could not be obtained because they required to be purchased while another 821 had some glaring grammatical errors and shallow language that they were deemed to be not sufficiently professional and scholarly. 22 studies ended up meeting the inclusion criteria to the letter and were thus included in the systematic review. An additional 3 studies that met the inclusion criteria also found by looking at the references of the 22 eligible studies. This made the total number of articles meeting the inclusion criteria to be 25. It is only ten out of these 25 studies that are reviewed in this paper for practical purposes. The flow diagram below illustrates this process by which the last 25 articles were selected for inclusion into the systematic review. It is followed by a table that synthesizes ten of those studies included in the review.
The flow diagram below shows in a step-wise fashion the way the number f studies included in the review was arrived at. It begins with the total number of studies obtained after the initial search. These are then systematically narrowed down to the studies that fit the criteria by applying those same criteria.
Looking at the evidence table in which the 10 studies have been synthesized, it is clear that out of the ten primary studies, only one was a level I study (Korevaar et al., 2003). The remaining nine were level II studies. A synthesis of the studies in the table clearly answers the ICOT question in that many of these reviewed studies overwhelmingly recommend home PD over facility HD as the most efficacious RRT dialysis modality for better patient outcomes.
Discussion
The research problem in this paper was finding the best dialysis modality that would bring about the best patient outcomes between home peritoneal dialysis (PD) and facility hemodialysis (HD). From the studies synthesized in the table above, the major findings are that in general home peritoneal dialysis has better chances of survival and is also better at giving the patient a better quality of life than facility HD. However, some of the studies have shown that this could only be true for up to a period of two years. After this, there is bound to be technique failure with PD and the patient may need to transition to HD. The findings are important because they inform evidence-based practice or EBP. An alternative explanation to the findings is that the studies had many confounding variables with other methodological shortcomings such that the results are unreliable. This would mean the outcome is not true. Limitations in the studies were many. They include non-randomization and bias in the selection of convenience samples in majority of the studies. Future research should focus on how PD and HD can be successfully used at different periods by the same patient in order to get the best benefits from both. Systematic Review Research Paper Example
References
American Kidney Fund (2021). Stages of chronic kidney disease (CKD). https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/stages-of-chronic-kidney-disease/#:~:text=Stage%204%20CKD%20means%20you,last%20stage%20before%20kidney%20failure
Choi, S.J., Obi, Y., Ko, G.J., You, A.S., Eriguchi, R., Wang, M., Rhee, C.M., & Kalantar-Zadeh, K. (2020). Comparing patient survival of home hemodialysis and peritoneal dialysis patients. American Journal of Nephrology, 51(3), 192-200. https://doi.org/10.1159/000504691
Ferguson, T.W., Whitlock, R.H., Bamforth, R.J., Beaudry, A., Darcel, J., Di Nella, M., Rigatto, C., Tangri, N., & Komenda, P. (2020). Cost-utility of dialysis in Canada: Hemodialysis, peritoneal dialysis, and nondialysis treatment of kidney Q1 failure. Kidney Medicine. https://doi.org/10.1016/j.xkme.2020.07.011
Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. McGraw-Hill Education.
Jung, H-Y., Jeon, Y., Park, Y., Kim, Y.S., Kang, S-W., Yang, C.W., Kim, N-H., Choi, J-Y., Cho, J-H., Park, S-H., Kim, C-D., & Kim, Y-L. (2019). Better quality of life of peritoneal dialysis compared to hemodialysis over a two-year period after dialysis initiation. Scientific Reports, 9(10266), 1-10. https://doi.org/10.1038/s41598-019-46744-1
Korevaar, J.C., Feith, G.W., Dekker, F.W., van Manen, J.G., Boeschoten, E.W., Bossuyt, P.M.M., & Krediet, R.T. (2003). Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: A randomized controlled trial. Kidney International, 64(6), 2222-2228. https://doi.org/10.1046/j.1523-1755.2003.00321.x
Lee, S.W., Lee, N.R., Son, S.K., Kim, J., Sul, A.R., Kim, Y., Park,J.T., Lee, J.P., & Ryu, D-R. (2019). Comparative study of peritoneal dialysis versus hemodialysis on the clinical outcomes in Korea: A population-based approach. Scientific Reports, 9(5905), 1-7. https://doi.org/10.1038/s41598-019-42508-z
McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, 8th ed. Elsevier, Inc.
Nadeau-Fredette, A-C., Hawley, C.M., Pascoe, E.M., Chan, C.T., Clayton, P.A., Polkinghorne, K.R., Boudville, N., Leblanc, M., & Johnson, D.W. (2015). An incident cohort study comparing survival on home hemodialysis and peritoneal dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clinical Journal of the American Society of Nephrology, 10(8), 1397-1407. https://doi.org/10.2215/CJN.00840115
National Kidney Foundation (2021). Estimated glomerular filtration rate (eGFR). https://www.kidney.org/atoz/content/gfr
Pajek, J., Hutchison, A.J., Bhutani, S., Brenchley, P.E.C., Hurst, H., Perme, M.P., Summers, A.M., & Vardhan, A. (2014). Outcomes of peritoneal dialysis patients and switching to hemodialysis: A competing risks analysis. Peritoneal Dialysis International, 34(3), 289–298. https://doi.org/10.3747/pdi.2012.00248
Rydell, H., Clynea, N., & Segelmark, M. (2016). Home- or institutional hemodialysis? – A matched pair-cohort study comparing survival and some modifiable factors related to survival. Kidney & Blood Pressure Research, 41(4), 392-401. https://doi.org/10.1159/000443441
Rydell, H., Ivarsson, K., Almquist, M., Segelmark, M., & Clyne, N. (2019). Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: A matched cohort study. BMJ Nephrology, 20(52), 1-9. https://doi.org/10.1186/s12882-019-1245-x
Wong, B., Ravani, P., Oliver, M.J., Holroyd-Leduc, J., Venturato, L., Garg, A.X., & Quinn, R.R. (2017). Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases, 71(3), 344–351. https://doi.org/10.1053/j.ajkd.2017.08.028
Create a systematic review research paper. For the question “Does at home peritoneal dialysis improve patient outcomes, when compared to facility hemodialysis in patients with end stage renal disease”.
Population and their problem: Adults with end stage renal disease
Intervention or issue/exposure: At home peritoneal dialysis
Comparative intervention: Facility hemodialysis
Outcomes or themes: Improved patient outcome
Timeframe: n/a
- Use PubMed database, pick only 10 articles.
- Needs to be a primary source. Not another systematic review.
- Abstract, Introduction, Methods, Results, flow diagram, results table, discussion, and any limitations.
- Research Flow diagram and results template included, check downloads.
Method section should include: Start off by stating you searched the literature published in English in PubMed and list the last date of search. With no restrictions on how long ago a study was published. List inclusion and exclusion criteria providing explanation and justifications as needed. List the key words and describe search.
Results section: should start off by stating. The search of PubMed provided a total of [#] articles. After removing [#] duplicates, the titles and abstracts of [#]articles were screened. Of these, [#] studies were excluded because it appeared that these articles did not meet the inclusion criteria [cannot answer the research question]. The full-text of [#]articles were searched. [Give #s and reasons for exclusions of full-text articles. For example, the full text of # articles were not available for free. # articles could not be feasibly translated into English.] [#] studies met the inclusion criteria and were included in the systematic review(citations in APA format). An additional [#] studies that met the criteria for inclusion were identified by checking the references of the eligible studies(citation of articles found in APA format). Provide a flow diagram base off the 10 articles. Flow diagram template include in down loads.
Include table with results for each article that met the criteria for inclusion. There is a table template include in downloads.
2nd paragraph describes flow diagram. Add a last sentence in the first paragraph which summarizes the results, making sure to answer your PICOT question.
1) The next paragraph synthesizes the level of evidence of the studies that are included (articles at the bottom of flow diagram).a. How many were level I, how many were level II, and how many were level III? I) Answer your PICOT question as it relates to level of evidence.
2) The next paragraph synthesizes the “P” and the “C” (if applicable) across your studies. Do the same for all the items in this column of your table. b. Answer your PICOT question as it pertains to the “P” or “C”.
3) The next paragraph synthesizes the “I” across your studies. Answer your PICOT question as it pertains to “I”.
4) The next paragraph synthesizes the “O” across your studies. Answer your PICOT question as it pertains to “O”
5) The next paragraph synthesizes the statistics across your studies. Answer your PICOT question as it pertains to the statistics.
6) The next paragraph synthesizes the adverse events (common with experimental designs) or attrition (common with longitudinal designs) across your studies. Answer your PICOT question as it pertains to the adverse events or attrition. Here is an example:
7) The next paragraph synthesizes the quality of the articles across the studies. Answer your PICOT question as it pertains to quality.
8) The next paragraph synthesizes the theory/conceptual models across your studies. Answer your PICOT question as it pertains to theory/conceptual models. Systematic Review Research Paper Example