CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 120 AFRICA CAC or AAC score did not change, demonstrating that the pooled results were robust. A considerable number of sources of heterogeneity existed among the studies included in this meta-analysis, mainly from different countries of origin, diverse study models, and different dosages and duration of STS administration. We used the Cochrane risk-of-bias tool to evaluate the risk of bias of seven RCTs, shown in Figs 9 and 10. Two studies22,35 had a low risk of bias, one with some concern32 and four a high risk of bias.23,27,30,34 The ‘high’ risk of bias judgment was mainly owing to attrition bias due to blinding of participants (performance bias). Based on the risk of bias in non-randomised studies of interventions tool, the non-RCT29 was evaluated as having a low risk of bias. 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 iPTH level Bian 2021 360.52 145.2 25 347.73 128.72 25 17.0% 0.09 [–0.46, 0.65] Djuric 2019 143.48 49.08 26 212.72 83.68 26 17.0% –0.99 [–1.57, –0.42] Li 2021 643.42 62.31 35 907.32 86.21 35 16.5% –3.47 [–1.22, –2.72] Mao 2018 572.32 92.76 15 391.74 35.03 15 15.8% 2.51 [1.52, 3.49] Saengpanit 2019 151.25 79.75 26 192.75 96.25 26 17.0% –0.46 [–1.01, 0.09] Yu 2016 768.5 639.63 15 1,098.5 950.02 15 16.6% –0.40 [–1.12, 0.33] Subtotal (95% CI) 142 142 100.0% –0.47 [–1.69, 0.74] Heterofeneity: Tau2 = 2.19; Chl2 = 101.85, df = 5 (p < 0.00001); I2 = 95% Test for overall effect: Z = 0.76 (p = 0.44) Total (95% CI) 142 142 100.0% –0.47 [–1.69, 0.74] Heterofeneity: Tau2 = 2.19; Chl2 = 101.85, df = 5 (p < 0.00001); I2 = 95% Test for overall effect: Z = 0.76 (p = 0.44) –4 –2 0 2 4 Favours [pre-STS] Favours [post-STS] Fig. 6. Forest plot of STS treatment on changes in serum iPTH 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 bicarbonate measurements Djuric 2019 22.4 4 26 22 2.5 26 28.3% 0.12 [–0.43, 0.66] Li 2021 25.25 2.04 35 22.3 3.41 35 30.3% 1.04 [0.54, 1.54] Mao 2019 24.36 2.05 15 22 3.42 15 20.6% 0.81 [0.07, 1.56] Yu 2016 24.4 2 15 22.3 3.4 15 20.8% 0.73 [–0.01, 1.48] Subtotal (95% CI) 91 91 100.0% 0.67 [0.22, 1.11] Heterofeneity: Tau2 = 0.11; Chl2 = 6.20, df = 3 (p = 0.10); I2 = 52% Test for overall effect: Z = 2.93 (p = 0.003) Total (95% CI) 91 91 100.0% 0.67 [0.22, 1.11] Heterofeneity: Tau2 = 0.11; Chl2 = 6.20, df = 3 (p = 0.10); I2 = 52% Test for overall effect: Z = 2.93 (p = 0.003) Test for subgroup differences: Not applicable –2 –1 0 1 2 Favours [pre-STS] Favours [post-STS] Fig. 7. Forest plot of STS treatment on changes in serum bicarbonate 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 hsCRP Bian 2021 1.69 0.59 25 1.02 0.11 25 20.3% 1.55 [0.92, 2.19] Li 2021 7.99 0.72 35 5.03 0.43 35 19.3% 4.94 [3.97, 5.90] Mao 2019 7.61 3.12 15 5.44 1.97 15 20.0% 0.81 [0.06, 1.56] Saengpanit 2019 2.35 1 24 2.43 1.48 24 20.5% –0.06 [–0.63, 0.50] Yu 2016 7.6 3.15 15 5.17 1.27 15 19.9% 0.98 [0.22, 1.75] Subtotal (95% CI) 114 114 100.0% 1.61 [0.19, 3.04] Heterofeneity: Tau2 = 2.49; Chl2 = 79.43, df = 4 (p < 0.00001); I2 = 95% Test for overall effect: Z = 2.22 (p = 0.03) Total (95% CI) 114 114 100.0% 1.61 [0.19, 3.04] Heterofeneity: Tau2 = 2.49; Chl2 = 79.43, df = 4 (p < 0.00001); I2 = 95% Test for overall effect: Z = 2.22 (p = 0.03) –4 –2 0 2 4 Favours [pre-STS] Favours [post-STS] Fig. 8. Forest plot of STS treatment on changes in serum bicarbonate level in dialysis patients with end-stage renal disease.
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