Funnel Plot Analysis
Risk of transfusion (Seven studies)
Risk of >4 units pRBCs (Four studies)
Risk of re-operation for bleeding (Fourteen studies)
Search Strategy
MEDLINE
1
((renal or kidney$) adj (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or function$ or
dysfunction or disorder$)).tw. and ((renal or kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine
or gfr$).ti,hw. or (cohort and (blood$ or bleed$ or transfus$)).mp. or exp Epidemiologic Studies/ or (outcome$ or
mortality or risk$ or survival or morbidity).ti.)
2
((chronic or impair$) adj (renal or kidney$ or glomerulonephr$ or nephr$ or ur?emi$)).tw. and ((renal or
kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or exp
Epidemiologic Studies/ or (outcome$ or mortality or risk$ or survival or morbidity).ti.)
3
((end stage or endstage or end-stage or pre-end-stage) adj (renal or kidney$)).tw. and ((renal or kidney$
or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or exp Epidemiologic
Studies/ or (outcome$ or mortality or risk$ or survival or morbidity).ti.)
4
(predialy$ or pre-dialy$ or kdoqi or k-doqi).tw. and ((renal or kidney$ or glomer$ or nephr$ or dialys$ or
h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or exp Epidemiologic Studies/ or (outcome$ or mortality or
risk$ or survival or morbidity).ti.)
5
((renal or kidney$) and (ckd or ckf or crd or crf or eskd or eskf or esrd or esrf or pre-esrd or dialy$ or
h?emodialy$)).tw. and (renal or kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or
gfr$).ti,hw.
6
(gfr or glomerul$ filtr$ or eCcr$ or MDRD$ or cGFR or serum creatinine or creatinine clearance or screatinine).tw.
7
((estimat$ or predict$ or automat$ or report$ or calculat$) adj (eGFR or Ccr or eCcr or MDRD$)).tw.
8
(((pre-operative or elevated or preoperative) adj creatinine) or (creatinine adj (ratio or level$))).tw.
9
(creatinine and ((renal or kidney$) adj (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or
function$ or dysfunction or disorder$))).tw.
10
((pre-operativ$ or preoperativ$ or pre-existing) adj (renal$ or creatinine or kidney or mild renal or
ur?emi$ or dialys$ or h?emodialy$ or non-dialys$)).tw.
11
exp Renal Insufficiency, Chronic/ or Renal Insufficiency/ or (transfus$ and blood cell$).ti. or *Erythrocyte
Transfusion/
12
exp Renal Dialysis/ or (creatinine and micromol$).tw.
13
or/1-12
14
((renal or kidney$) adj2 (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or function$ or
dysfunction or disorder$)).ti. and ((end stage or endstage or end-stage or pre-end-stage or chronic) adj (renal or
kidney$)).tw.
15
((chronic or impair$) adj (renal or kidney$ or glomerulonephr$ or nephr$ or ur?emi$)).ti.
16
((end stage or endstage or end-stage or pre-end-stage) adj (renal or kidney$)).ti.
17
(renal or kidney$).ti. and (ckd or ckf or crd or crf or eskd or eskf or esrd or esrf or pre-esrd or dialy$ or
h?emodialy$).tw.
18
(*kidney disease/ or *kidney failure/ or *kidney/ or *glomerulus filtration rate/ or exp *kidney function
test/) and ((chronic or impair$ or end stage or endstage or end-stage or pre-end-stage) adj (renal or kidney$)).tw.
19
exp *Renal Insufficiency, Chronic/ or exp *Renal Dialysis/ or *Renal Insufficiency/ or *Creatinine/ or
Kidney Diseases/bl
20
(serum creatinine or creatinine clearance or (creatinine adj (ratio or level$))).ti.
21
or/14-20
22
((abdominal or aneurysm or aortic or grafting or cardi$ or carotid or coronar$ or elective or general or
heart or major or off-pump or parathyroid or serum or renal dysfunction) and (surgery$ or pre-operativ$ or
preoperativ$ or intraoperativ$ or perioperative$ or peri-operative$ or operative)).ti.
23
*Surgical Procedures, Operative/ or exp Cardiac Surgical Procedures/ or exp Thoracic Surgical Procedures/
or Surgical Procedures, Elective/ or Reoperation/ or *Perioperative Care/ or *Postoperative Care/ or exp
*Postoperative Period/ or exp *Preoperative Care/ or *Preoperative Period/ or *Intraoperative Period/ or
*Intraoperative Care/ or *Ambulatory Surgical Procedures/ or exp *Intraoperative Complications/ or exp
*Postoperative complications/ or exp *Femoral Fractures/su
24
*Abdomen/su or *Aortic Aneurysm, Abdominal/ or *Heart Valve Prosthesis/ or *Heart Valves/su or
*Hyperparathyroidism,Secondary/su or *Leg/bs or Blood Loss,Surgical/ or Blood Vessel Prosthesis Implantation/
25
exp Coronary Artery Bypass/ or exp Coronary Disease/su or exp *Heart Diseases/su
26
(((coronary or aortocoronar$ or cardio$ or infrainguinal) adj3 bypass$) or CABG).tw.
27
Carotid Stenosis/ or Endarterectomy,Carotid/ or exp *Cardiovascular Diseases/su
28
Cardiopulmonary Bypass/ and surg$.af.
29
Lower Extremity/bs or Vascular Surgical Procedures/
30
*Aortic Aneurysm/su
31
((aneurysm$ or endovascular) and (aortic or repair$ or surg$ or operation or reoperation)).ti.
32
Endarterectomy, Carotid/ or exp Carotid Artery Diseases/su or ((endarterectom$ or revascularization$)
and carotid$).ti.
33
((abdominal or aneurysm or aortic or grafting or cardiac or cardiovascular or carotid or coronary or
elective or general or heart or major or off-pump or parathyroid or heart valve or cardiac valve) adj (surgery$ or
dissection)).tw.
34
(carotid adj5 (surger$ or endarterectom$ or stent$)).ti.
35
lower extremit$.ti. or (infrainguinal$ adj2 (bypass or graft$)).tw. or (limb adj (isch?emia or salvage)).tw.
36
(carotid adj2 (surger$ or endarterectom$ or stent$)).tw.
37
((cardi$ adj2 surgery) or ((myocardial or coronar$ or arterial or extremity or off-pump or surgical) adj2
revascul$)).tw.
38
*Arterial Occlusive Diseases/su or *Ischemia/su or Limb Salvage/ or Peripheral Vascular Diseases/su or
exp *Aneurysm/su
39
or/22-38
40
13 and 39
41
(Postoperative care/ or Intraoperative care/ or Perioperative care/ or Postoperative complications/ or
Preoperative care/) and surg$.af.
42
(pre-operativ$ or preoperativ$ or intraoperativ$ or perioperative$ or peri-operative$ or post-operativ$ or
postoperativ$).tw. and surg$.af.
43
Aortic Aneurysm, Abdominal/
44
(((coronary or aortocoronar$ or cardio$) adj3 bypass$) or CABG).tw.
45
Leg/bs
46
((aneurysm$ or endovascular) and (aortic or repair$ or surg$ or operation or reoperation)).ti.
47
((endarterectom$ or revascularization$) and carotid$).tw. or (bleeding or blood-loss).ti.
48
or/41-47
49
21 and 48
50
40 or 49
EMBASE
1
((renal or kidney$) adj (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or function$ or
dysfunction or disorder$)).tw. and ((renal or kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine
or gfr$).ti,hw. or (cohort and (blood$ or bleed$ or transfus$)).mp. or controlled study/ or major clinical study/ or
comparative study/ or retrospective study/ or (outcome$ or mortality or risk$ or survival or morbidity).ti.)
2
((chronic or impair$) adj (renal or kidney$ or glomerulonephr$ or nephr$ or ur?emi$)).tw. and ((renal or
kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or controlled
study/ or major clinical study/ or comparative study/ or retrospective study/ or (outcome$ or mortality or risk$ or
survival or morbidity).ti.)
3
((end stage or endstage or end-stage or pre-end-stage) adj (renal or kidney$)).tw. and ((renal or kidney$
or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or controlled study/ or
major clinical study/ or comparative study/ or retrospective study/ or (outcome$ or mortality or risk$ or survival or
morbidity).ti.)
4
(predialy$ or pre-dialy$ or kdoqi or k-doqi).tw. and ((renal or kidney$ or glomer$ or nephr$ or dialys$ or
h?emodialy$ or creatinine or gfr$).ti,hw. or cohort.mp. or controlled study/ or major clinical study/ or comparative
study/ or retrospective study/ or (outcome$ or mortality or risk$ or survival or morbidity).ti.)
5
((renal or kidney$) and (ckd or ckf or crd or crf or eskd or eskf or esrd or esrf or pre-esrd or dialy$ or
h?emodialy$)).tw. and (renal or kidney$ or glomer$ or nephr$ or dialys$ or h?emodialy$ or creatinine or
gfr$).ti,hw.
6
(gfr or glomerul$ filtr$ or eCcr$ or MDRD$ or cGFR or serum creatinine or creatinine clearance or screatinine).tw.
7
((estimat$ or predict$ or automat$ or report$ or calculat$) adj (eGFR or Ccr or eCcr or MDRD$)).tw.
8
(((pre-operative or elevated or preoperative) adj creatinine) or (creatinine adj (ratio or level$))).tw.
9
(creatinine and ((renal or kidney$) adj (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or
function$ or dysfunction or disorder$))).tw.
10
((pre-operativ$ or preoperativ$ or pre-existing) adj (renal$ or creatinine or kidney or mild renal or
ur?emi$ or dialys$ or h?emodialy$ or non-dialys$)).tw.
11
chronic kidney failure/ or *kidney failure/ or exp kidney dysfunction/ or chronic kidney disease/ or
(transfus$ and blood cell$).ti. or *erythrocyte transfusion/
12
dialysis/ or hemodialysis patient/ or renal replacement therapy/ or hemodialysis/ or peritoneal dialysis/ or
(creatinine and micromol$).tw.
13
or/1-12
14
((renal or kidney$) adj2 (disease$ or failure$ or insufficien$ or impair$ or sufficien$ or function$ or
dysfunction or disorder$)).ti. and ((end stage or endstage or end-stage or pre-end-stage or chronic) adj (renal or
kidney$)).tw.
15
((chronic or impair$) adj (renal or kidney$ or glomerulonephr$ or nephr$ or ur?emi$)).ti.
16
((end stage or endstage or end-stage or pre-end-stage) adj (renal or kidney$)).ti.
17
(renal or kidney$).ti. and (ckd or ckf or crd or crf or eskd or eskf or esrd or esrf or pre-esrd or dialy$ or
h?emodialy$).tw.
18
(*kidney disease/ or *kidney failure/ or *kidney/ or *glomerulus filtration rate/ or *kidney function/ or
kidney function test/) and ((chronic or impair$ or end stage or endstage or end-stage or pre-end-stage) adj (renal
or kidney$)).tw.
19
*chronic kidney failure/ or exp *kidney dysfunction/ or exp *renal replacement therapy/ or *chronic
kidney disease/ or *dialysis/ or *hemodialysis patient/ or *creatinine blood level/ or *creatinine clearance/
20
(serum creatinine or creatinine clearance or (creatinine adj (ratio or level$))).ti.
21
or/14-20
22
((abdominal or aneurysm or aortic or grafting or cardi$ or carotid or coronar$ or elective or general or
heart or major or off-pump or parathyroid or serum or renal dysfunction) and (surgery$ or pre-operativ$ or
preoperativ$ or intraoperativ$ or perioperative$ or peri-operative$ or operative)).ti.
23
*aorta surgery/ or *cardiovascular surgery/ or *endovascular surgery/ or *general surgery/ or
*intraoperative period/ or *major surgery/ or *perioperative period/ or *peroperative care/ or *peroperative
complication/ or *postoperative complication/ or *surgery/ or *surgical risk/ or *thoracic aorta surgery/ or
*vascular surgery/ or *abdominal surgery/ or *aneurysm surgery/ or *bypass surgery/ or *elective surgery/ or exp
*abdominal surgery/ or exp *off pump surgery/ or exp *postoperative period/ or exp *preoperative period/ or
*heart valve surgery/ or *infrainguinal bypass surgery/ or *off pump coronary surgery/ or *reoperation/ or surgical
mortality/ or *surgical risk/ or *hip fracture/su
24
*abdomen/su or abdominal aorta aneurysm/su or exp *aorta aneurysm/su or exp *heart valve/su or
*secondary hyperparathyroidism/su or *leg blood flow/ or blood vessel transplantation/
25
exp coronary artery surgery/ or exp coronary artery disease/su or *heart disease/su or *heart
infarction/su or *heart surgery/ or *heart valve surgery/ or *heart muscle revascularization/
26
(((coronary or aortocoronar$ or cardio$ or infrainguinal) adj3 bypass$) or CABG).tw.
27
carotid artery obstruction/ or exp carotid artery surgery/ or *cardiovascular disease/su or *vascular
disease/su
28
cardiopulmonary bypass/ and surg$.af.
29
exp leg revascularization/ or *leg ischemia/ or exp *leg amputation/ or *leg/ or *ischemia/su or exp
*carotid artery disease/su
30
exp *aorta aneurysm/su or *aneurysm surgery/
31
((aneurysm$ or endovascular) and (aortic or repair$ or surg$ or operation or reoperation)).ti.
32
carotid endarterectomy/ or exp carotid artery disease/su or ((endarterectom$ or revascularization$) and
carotid$).ti.
33
((abdominal or aneurysm or aortic or grafting or cardiac or cardiovascular or carotid or coronary or
elective or general or heart or major or off-pump or parathyroid or heart valve or cardiac valve) adj (surgery$ or
dissection)).tw.
34
(carotid adj5 (surger$ or endarterectom$ or stent$)).ti.
35
lower extremit$.ti. or (infrainguinal$ adj2 (bypass or graft$)).tw. or (limb adj (isch?emia or salvage)).tw.
36
(carotid adj2 (surger$ or endarterectom$ or stent$)).tw.
37
((cardi$ adj2 surgery) or ((myocardial or coronar$ or arterial or extremity or off-pump or surgical) adj2
revascul$)).tw.
38
*ischemia/su or limb salvage/ or peripheral vascular disease/su or exp *aneurysm/su
39
or/22-38
40
13 and 39
41
(perioperative period/ or exp postoperative period/ or exp preoperative period/ or operation duration/ or
peroperative care/ or peroperative complication/) and surg$.af.
42
(pre-operativ$ or preoperativ$ or intraoperativ$ or perioperative$ or peri-operative$ or post-operativ$ or
postoperativ$).tw. and surg$.af.
43
abdominal aorta aneurysm/ or surgery/ or abdominal surgery/ or aneurysm surgery/ or bypass surgery/
or elective surgery/ or heart valve surgery/ or infrainguinal bypass surgery/ or off pump coronary surgery/ or
surgical mortality/ or surgical risk/ or reoperation/
44
(((coronary or aortocoronar$ or cardio$) adj3 bypass$) or CABG).tw.
45
leg blood flow/ or exp leg revascularization/ or leg ischemia/ or exp leg amputation/
46
((aneurysm$ or endovascular) and (aortic or repair$ or surg$ or operation or reoperation)).ti.
47
((endarterectom$ or revascularization$) and carotid$).tw. or (bleeding or blood-loss).ti.
48
or/41-47
49
21 and 48
53
40 or 49
Reporting Check List
Reporting of background
- Problem definition
✓, CKD and bleeding stated in introduction
- Hypothesis statement
✓
- Description of study outcomes
✓
- Type of exposure or intervention used
✓
- Type of study designs used
✓
Reporting of search strategy
- Qualification of searchers
✓, MD (PGY-3), Graduate student (M.Sc).
- Search strategy
✓, see Appendix
- Included all available studies, contact with authors
✓, no contact with authors
- Databases and registries searched
✓, actual databases not searched
- Software used, name, version, special features
✓, see Methods
- Hand searching
✓, from reviews and reference list of
articles
- List of citations located and those excluded
✓, excel spreadsheet provided
- Method of addressing articles not published in English
✓, see references
- Method of handling abstracts and unpublished studies
✓, full text articles included only
- Description of any contact with authors
✓, no contact with authors
Reporting of methods
- Description of relevance or appropriateness of studies
✓, see Methods, Table 2
- Rationale for selection and coding of data
✓, see Methods, Figure 1
- Documentation of data coding and classification
✓
- Assessment of confounding
✓, See Table 5
- Assessment of study quality
✓, see Methods, Table 2
- Assessment of heterogeneity
✓, see Appendix for funnel plot analyses
- Description of statistical methods
✓
- Provision of appropriate tables and graphics
✓
Reporting of results
- Graphic summarizing individual/overall study estimates
✓
- Table giving descriptive information of each study
✓, see table 1
- Results of sensitivity testing
✓
- Indication of statistical uncertainty of findings
✓, see discussion
Reporting of discussion
- Quantitative assessment of bias (publication bias)
✓, funnel plot
- Justification for exclusion (e.g. non-English articles)
✓, see references
- Assessment of quality of included studies
✓, see table 2
Reporting of conclusions
- Consideration of alternative explanations
✓
- Generalization of conclusions
✓
- Guidelines for future research
✓
- Disclosure of funding source
✓, no funding sources to disclose