The Consistency and Reporting of Quality-of-Life Outcomes in Trials of Immunosuppressive Agents in Kidney Transplantation: A Systematic Review and Meta-analysis.
Howell M, Wong G, et al.American Journal of Kidney Diseases 2016; 67(5): 762-774.
Aims
To evaluate the frequency and reliability of quality of life (QoL) outcomes reported in randomized controlled trials (RCTs) of maintenance immunosuppression following kidney transplantation.
Interventions
A systematic review was conducted which included all RCTs of maintenance immunosuppression interventions following kidney transplantation. There was no restriction by language, drugs, age of recipient, or multiple organ transplants, and included databases (The Cochrane Kidney and Transplant Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to October 3, 2015.
Participants
41 reports of 23 trials were included in the analysis.
Outcomes
Measured outcomes included QoL measures, defined as patient-reported outcomes providing a quantitative measure of physical, emotional or social well-being. Additionally the clinical outcomes of mortality, transplant failure, acute rejection, kidney function, treatment failure, and hospitalization time were measured.
Follow-up
Median duration of follow-up was 12 (range, 1-48) months
CET Conclusions
This interesting systematic review analysed the frequency and reliability of quality of life (QoL) measures reported in randomized controlled trials (RCTs) of immunosuppressive drugs in kidney transplantation. A comprehensive bibliographic search was conducted although it was unclear whether the selection of RCTs for inclusion was done by more than one reviewer. Risk of bias was independently assessed by two reviewers using the Cochrane tool but it was unclear whether the data for QoL and clinical outcomes were extracted in duplicate. The reviewers attempted to obtain further information in case of unclear reports or missing data from the authors of the included studies. Only 1.8% of reports of eligible RCTs included a measure of QoL. The QoL instruments were generic (36%), disease specific (9%) or symptom specific (55%). Overall risk of bias of RCTs was considered moderate to high in 65% of studies. Reporting of QoL outcomes was incomplete for most trials. Despite being an important outcome for kidney transplant recipients, QoL outcomes are rarely assessed and methodological deficiencies further limit their meaning.
Quality notes
Quality assessment not appropriate
Trial registration
None