Abstract
Background: We require an quantitative imaging technique for the diagnosis and assessment of chronic kidney disease (CKD). Renal elastography has been widely used in recent years in different studies; however, the results across them are not consistent and, as a result, we conducted a meta-analysis of the published literature on this topic. Methods: The databases of PubMed, Medscape, Medline were searched for all studies published in English from 2010 until November 2021 that evaluated kidney shear wave speed (SWS) by elastography in patients with CKD. Trial design, methodological information, patient characteristics, interventions, results, and outcome data were all collected from each study according to a set protocol. Results: We found 37 publications, yet only 18 studies that utilized point shear wave elastography (Virtual Touch Quantification—VTQ system) were compared because the values achieved using different types of elastography are not evaluable. Finally, 1995 attendees (1241 patients with CKD versus 781 healthy subjects as the control group) were included. When comparing mean values of kidney SWS between studies we found increased heterogeneity Q = 513.133; DF = 10; p < 0001, I2 (inconsistency) = 98.12% (95% CI for I2 97.52–98.57%). With a standardized mean difference of −0.216, patients with CKD have a lower kidney SWS than healthy controls. A positive association between kidney SWS and eGFR was also discovered across the presented studies, with a pooled correlation coefficient of 0.38 (Z = 10.3, p < 0.001), Q = 73.3, DF = 5, p < 000.1, I2 = 93.18% (95% CI for I2 87.86 to 96.18). The pooled area under the ROC curve for kidney SWS to predict chronic kidney disease was 0.831 (95% CI, p < 0.001), Q = 28.32, DF = 6, p = 0.0001, I2 = 78.8% (95% CI for I2 56.37 to 89.72). In the four articles that used the Elast-PQ method, the data presented were insufficient for statistical analysis: area under the curve (AUC) values are used to compare distinct characteristics (differentiating kidney SWS between mildly and moderately impaired kidneys, between non-diabetic/prediabetic/diabetic patients, or kidney SWS between the CKD and control group), therefore not being suitable for further evaluation. Conclusions: The results show that patients with CKD have a lower kidney SWS than healthy controls. However, the number of studies involving renal elastography that have been published is limited and show an increased heterogeneity. Further research is needed to determine which factors actually influence kidney SWS in CKD patients and, as a result, to specify the role and indication of renal elastography in clinical practice.
Highlights
Chronic kidney disease (CKD) is becoming more prevalent, and its progression is linked to increased morbidity, mortality, and healthcare costs. [1] As a consequence, it is essential to diagnose chronic kidney disease (CKD) earlier and accurately measure the disease’s progression using several markers
Ultrasound provides us with some non-quantifiable evidence on the echogenicity of the renal cortex, which increases when fibrosis advances in the later stages of CKD when the kidneys stiffen
Year of publication, patients, etiology of chronic kidney disease, technical failures, renal biopsy used for the evaluation of fibrosis in CKD, the quality of specimen obtained in renal biopsy, the correlation coefficient between kidney shear wave speed (SWS) and eGFR, the area under the curve (AUC) and cut-off values for predicting CKD were all extracted
Summary
Chronic kidney disease (CKD) is becoming more prevalent, and its progression is linked to increased morbidity, mortality, and healthcare costs. [1] As a consequence, it is essential to diagnose CKD earlier and accurately measure the disease’s progression using several markers (biomarkers, histology, imaging). Ultrasound provides us with some non-quantifiable evidence on the echogenicity of the renal cortex, which increases when fibrosis advances in the later stages of CKD when the kidneys stiffen. In ARFI-based elastography, a transducer similar to the one integrated into an ultrasound machine is used to generate shear waves inside the organ that propagate through the soft tissue. The speed of these shear waves (SWS) is progressively reduced, and this is corresponding to tissue stiffness. We performed a meta-analysis in order to compare different results obtained using elastography in the assessment of chronic kidney disease
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