CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 119 Adverse effects related to intravenous STS treatment among dialysis patients on vascular calcification were reported in three studies.27,29,30 The most common symptoms were nausea and vomiting. Adirekkiat et al.29 reported poor appetite or anorexia among 15 of 20 patients (75%), resulting in two patients withdrawing from the study. Two other patients complained of persistently poor appetite and anorexia lasting up to 48 hours after the injection of STS. Other side effects included sneezing (19%), two cases of transient hypotension and one case of dizziness. Saengpanit reported anorexia and loss of appetite in 12.5% of patients, without discontinuation. Symptoms were relieved after the dose of intravenous STS was halved in the last four months.30 Other side effects included blushing in two patients and three transient events of intradialytic hypotension in two patients. No adverse events associated with intravenous STS treatment were described in other included studies. From the eight selected studies, the SMD and 95% CIs of each outcome were assessed using the fixed-effects and randomeffects models, respectively. The discrepancy between the two outcomes was small, demonstrating that the sensitivity of the integrated results was low. We also performed sensitivity analyses by excluding one trial from the same research team as another included trial. The effect of intravenous STS treatment on the STS Control Std. Mean Difference Std. Mean Difference Study or subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Djuric 2019 –1.8 2.7 26 0 2.7 29 51.9% –0.66 [–1.20, –0.11] Saengpanit 2018 –0.9 1.98 24 –0.02 2.54 25 48.1% –0.38 [–0.94, –0.19] Total (95% CI) 50 54 100.0% –0.52 [–0.92, –0.13] Heterofeneity: Tau2 = 0.00; Chl2 = 0.48, df = 1 (p < 0.49); I2 = 0% Test for overall effect: Z = 2.62 (p = 0.009) –4 –2 0 2 4 STS – Control Fig. 3. Forest plot of STS treatment on the increase in PWV in dialysis patients with end-stage renal disease. pre-STS post-STS Std. Mean Difference Std. Mean Difference Study or subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Effect of intravenous STS on serum Ca level Bian 2021 2.25 0.16 25 2.19 0.21 25 17.1% 0.32 [–0.24, 0.87] Djuric 2019 2.37 0.2 26 2.25 0.2 26 17.2% 0.59 [0.03, 1.15] Li 2021 2.28 0.22 35 2.58 0.21 35 17.4% –1.38 [–1.90, 0.86] Mao 2018 2.43 0.26 15 2.51 0.19 15 15.8% –0.34 [–0.06, 0.38] Saenopanit 2018 2.2 0.07 24 2.2 0.02 24 17.1% 0.00 [–0.57, 0.57] Yu 2016 2.35 0.2 15 2.54 0.22 15 15.5% –0.88 [–1.63, 0.12] Subtotal (95% CI) 140 140 100.0% –0.27 [–0.92, 0.37] Heterofeneity: Tau2 = 0.54; Chl2 = 34.05, df = 5 (p < 0.00001); I2 = 85% Test for overall effect: Z = 0.84 (p = 0.40) Total (95% CI) 140 140 100.0% –0.27 [–0.92, 0.37] Heterofeneity: Tau2 = 0.54; Chl2 = 34.05, df = 5 (p < 0.00001); I2 = 85% Test for overall effect: Z = 0.84 (p = 0.40) –4 –2 0 2 4 Favours [pre-STS] Favours [post-STS] Fig. 4. Forest plots of STS treatment on changes in serum calcium level in dialysis patients with end-stage renal disease. pre-STS post-STS Std. Mean Difference Std. Mean Difference Study or subgroup Mean SD Total Mean SD Total Weight IV, Random, 95% CI IV, Random, 95% CI Effect of intravenous STS on serum P level Bian 2021 1.69 0.27 25 1.75 0.24 25 28.1% –0.23 [–0.79, 0.33] Djuric 2019 1.41 0.4 26 1.68 0.5 26 28.1% –0.59 [–1.14, –0.03] Saengpanit 2018 1.65 0.24 24 1.71 0.36 24 27.0% –0.19 [–0.76, –0.37] Yu 2016 2.26 0.47 15 2.41 0.72 15 16.8% –0.24 [–0.96, 0.48] Subtotal (95% CI) 90 90 100.0% –0.32 [–0.62, –0.03] Heterofeneity: Tau2 = 0.00; Chl2 = 1.23, df = 3 (p < 0.75); I2 = 0% Test for overall effect: Z = 2.14 (p = 0.03) Total (95% CI) 90 90 100.0% –0.32 [–0.62, –0.03] Heterofeneity: Tau2 = 0.00; Chl2 = 1.23, df = 3 (p < 0.75); I2 = 0% Test for overall effect: Z = 2.14 (p = 0.03) –2 –1 0 1 2 Favours [pre-STS] Favours [post-STS] Fig. 5. Forest plots of STS treatment on changes in serum phosphate in dialysis patients with end-stage renal disease.
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