Wisit Cheungpasitporn, Wannasit Wathanavasin, Charat Thongprayoon, Wisit Kaewput, Mihály Tapolyai, Tibor Fülöp
{"title":"系统评价和荟萃分析的关键评估:肾脏病学家的一步一步指南。","authors":"Wisit Cheungpasitporn, Wannasit Wathanavasin, Charat Thongprayoon, Wisit Kaewput, Mihály Tapolyai, Tibor Fülöp","doi":"10.1080/0886022X.2025.2476736","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.</p><p><strong>Methods: </strong>This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I<sup>2</sup> statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.</p><p><strong>Results: </strong>The I<sup>2</sup> statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.</p><p><strong>Conclusion: </strong>By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2476736"},"PeriodicalIF":3.0000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951313/pdf/","citationCount":"0","resultStr":"{\"title\":\"Critical appraisal of systematic reviews and meta-analyses: a step-by-step guide for nephrologists.\",\"authors\":\"Wisit Cheungpasitporn, Wannasit Wathanavasin, Charat Thongprayoon, Wisit Kaewput, Mihály Tapolyai, Tibor Fülöp\",\"doi\":\"10.1080/0886022X.2025.2476736\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.</p><p><strong>Methods: </strong>This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I<sup>2</sup> statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.</p><p><strong>Results: </strong>The I<sup>2</sup> statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.</p><p><strong>Conclusion: </strong>By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.</p>\",\"PeriodicalId\":20839,\"journal\":{\"name\":\"Renal Failure\",\"volume\":\"47 1\",\"pages\":\"2476736\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951313/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Renal Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/0886022X.2025.2476736\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Renal Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0886022X.2025.2476736","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:系统评价和荟萃分析通过巩固多项研究的结果,在包括肾脏病学在内的循证医学中发挥着关键作用。为了使它们的效用最大化,在同行评审期间进行严格的质量评估是必不可少的。异质性、偏倚和方法缺陷等挑战往往会破坏这些研究,因此需要一个结构化的评估过程。方法:本指南概述了肾病学家评估系统评价和荟萃分析的框架。关键领域包括使用I2统计量进行异质性评估,对汇总效应估计的森林图进行解释,以及使用艾格检验的漏斗图来识别潜在的发表偏倚。随机对照试验使用rob2评估偏倚风险,非随机研究使用robins - 1评估偏倚风险。亚组和敏感性分析,以及元回归,处理异质性和检查结果的稳健性。结果:I2统计量通过估计meta分析中变异性的比例来量化异质性。漏斗图和艾格检验有助于检测发表偏倚。主要偏倚,如选择偏倚、性能偏倚、检测偏倚和发表偏倚,使用结构化工具如AMSTAR 2、Cochrane RoB 2和ROBINS-I来识别。GRADE框架进一步评估证据的总体确定性。重点放在PRISMA合规性、方案预注册以及统计分析、分组和敏感性评估的透明报告上。灰色文献的纳入仍然是可选的。结论:通过关注关键领域,如异质性、偏倚风险和可靠的统计方法,本指南使肾病学家能够批判性地评估系统评价和荟萃分析,促进更好的临床决策和改善肾病学患者护理。
Critical appraisal of systematic reviews and meta-analyses: a step-by-step guide for nephrologists.
Background: Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.
Methods: This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I2 statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.
Results: The I2 statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.
Conclusion: By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.
期刊介绍:
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.