The effect of exercise on vascular health in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials

Figures

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  Figure 1.. PRISMA 2020-compliant flow diagram using the PRISMA2020 R package (64). Automation tools were used to remove non-English language studies and conference abstracts in the Embase search. In reasons for exclusion, “Comparator” includes single-arm studies without a comparator as well as studies with an inappropriate comparator (e.g., comparator did not receive dietary intervention when the intervention arm did), and “Other” includes one article that was a protocol only, a review article, and a study that was an extended followup of an included study. Some studies may have had multiple reasons for exclusion; the reason recorded is in the order of participant, intervention, comparison, outcomes, and study design (PICOS). PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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  Figure 2.. RoB2 traffic light plot for the risk of bias of all included studies. This was produced using the R package robvis (90).

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  Figure 3.. Forest plots of the effect estimates [mean difference (MD)] with 95% confidence intervals (CI) for pulse wave velocity (in m/s) between exercise interventions and control groups for all included studies, with subgroup analysis of the chronic kidney disease (CKD) population. cf-PWV, carotid-femoral PWV; HD, hemodialysis; PD, peritoneal dialysis; I2, estimate of the proportion of observed variance that is due to real differences in effect size; τ, estimate of the SD of the true effect size.

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  Figure 4.. Forest plots of the effect estimates [mean difference (MD)] with 95% confidence intervals (CI) for the augmentation index (in %) between exercise interventions and control groups for all included studies, with subgroup analysis of the chronic kidney disease (CKD) population. HD, hemodialysis; I2, estimate of the proportion of observed variance that is due to real differences in effect size; τ, estimate of the SD of the true effect size.

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  Figure 5.. Forest plots of effect estimates [standardized mean difference (SMD)] with 95% confidence intervals (CI) for endothelial function measures between exercise interventions and control groups for all included studies [flow-mediated dilation (FMD) and reactive hyperemia index (RHI) as measured by peripheral arterial tonometry]. All results are end of trial means, not changes from baseline. I2, estimate of the proportion of observed variance that is due to real differences in effect size; τ, estimate of the SD of the true effect size.

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  Figure 6.. Funnel plot of the mean difference in pulse wave velocity (PWV) among patients with chronic kidney disease after exercise training interventions compared with control. Individual mean differences (in m/s) in PWV in each study are plotted against a measure of each study’s precision (the SE of the mean difference); any asymmetry in the plot indicates the degree of publication bias in the effect estimates. cf-PWV, carotid-femoral PWV.

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  Figure 7.. Funnel plot of the mean difference in augmentation index among patients with chronic kidney disease after exercise training interventions compared with control. Individual mean differences (in %) in the augmentation index in each study are plotted against a measure of each study’s precision (the SE of the mean difference); any asymmetry in the plot indicates the degree of publication bias in the effect estimates.