Multivariable models for advanced colorectal neoplasms in screen-eligible individuals at low-to-moderate risk of colorectal cancer: towards improving colonoscopy prioritization.

BACKGROUND: Advanced colorectal neoplasms (ACNs), including colorectal cancers (CRC) and high-risk adenomas (HRA), are detected in less than 20% of persons aged 50 years or older who undergo colonoscopy. We sought to derive personalized predictive models of risk of harbouring ACNs to improve colonoscopy wait times for high-risk patients and allocation of colonoscopy resources. METHODS: We characterized colonoscopy indications, neoplasia risk factors and colonoscopy findings through chart review for consecutive individuals aged 50 years or older who underwent outpatient colonoscopy at The Ottawa Hospital (Ottawa, Canada) between April 1, 2008 and March 31, 2012 for non-life threatening indications. We linked patients to population-level health administrative datasets to ascertain additional historical predictor variables and derive multivariable logistic regression models for risk of harboring ACNs at colonoscopy. We assessed model discriminatory capacity and calibration and the ability of the models to improve colonoscopy specificity while maintaining excellent sensitivity for ACN capture. RESULTS: We modelled 17 candidate predictors in 11,724 individuals who met eligibility criteria. The final CRC model comprised 8 variables and had a c-statistic value of 0.957 and a goodness-of-fit p-value of 0.527. Application of the models to our cohort permitted 100% sensitivity for identifying persons with CRC and > 90% sensitivity for identifying persons with HRA, while improving colonoscopy specificity for ACNs by 23.8%. CONCLUSIONS: Our multivariable models show excellent discriminatory capacity for persons with ACNs and could significantly increase colonoscopy specificity without overly sacrificing sensitivity. If validated, these models could allow more efficient allocation of colonoscopy resources, potentially reducing wait times for those at higher risk while deferring unnecessary colonoscopies in low-risk individuals.

A living donor kidney transplant recipient with mycobacterium senegalense bacteremia: A case report.

Mycobacterium senegalense is primarily known in sub-Saharan Africa to cause bovine farcy, a chronic granulomatous inflammation of the skin and lymphatics in cows. Reports of M. senegalense are rare among humans. We report a unique case of M. senegalense bloodstream infection in a living donor kidney transplant recipient with multiple possible sources of infection.

Point-of-care-ultrasound for the assessment of post-renal transplant recipients.

INTRODUCTION: Postoperative imaging for deceased donor renal transplants is often delayed, as these surgeries occur after-hours. These delays can be critical in identifying immediate complications. To our knowledge, there are no formal training programs for point-of-care ultrasound (POCUS) in this setting; therefore, we aimed to develop and evaluate a feasible and practical POCUS curriculum for the assessment of a renal transplant graft. METHODS: Urology and nephrology transplant physicians completed a three-hour online course, followed by a five-hour hands-on seminar for sonographic scanning. Simulated patients with transplanted kidneys were used. Course material was developed with licensed ultrasound technologists based on Sonography Canada national competency profiles. Pre- and post-course surveys focused on user confidence, while pre- and post-course multiple-choice questionnaires assessed theoretical knowledge. RESULTS: Twelve participants were included, six of whom were urologists. Theoretical knowledge in POCUS improved significantly (p<0.001). Confidence in manipulation of ultrasound controls, Doppler imaging, and POCUS of the transplant kidney also improved (all p<0.001, d>2.0). Participants indicated an increased likelihood of POCUS use in clinical practice and that training should be integrated into a transplant fellowship. CONCLUSIONS: We introduced a novel and guideline-based POCUS curriculum that leveraged local ultrasound educators and found improved theoretical knowledge and skill confidence in our cohort of transplant physicians. This course will serve as the first step toward a validated competency-based training system for POCUS use in the immediate post-renal transplant setting, and likely will be incorporated into the training of the modern transplant physician.

Implementation of a One-Day Living Kidney Donor Assessment Clinic to Improve the Efficiency of the Living Kidney Donor Evaluation: Program Report.

Purpose of program: A key barrier to becoming a living kidney donor is an inefficient evaluation process, requiring more than 30 tests (eg, laboratory and diagnostic tests), questionnaires, and specialist consultations. Donor candidates make several trips to hospitals and clinics, and often spend months waiting for appointments and test results. The median evaluation time for a donor candidate in Ontario, Canada, is nearly 1 year. Longer wait times are associated with poorer outcomes for the kidney transplant recipient and higher health care costs. A shorter, more efficient donor evaluation process may help more patients with kidney failure receive a transplant, including a pre-emptive kidney transplant (ie, avoiding the need for dialysis). In this report, we describe the development of a quality improvement intervention to improve the efficiency, effectiveness, and patient-centeredness of the donor candidate evaluation process. We developed a One-Day Living Kidney Donor Assessment Clinic, a condensed clinic where interested donor candidates complete all testing and consultations within 1 day. Sources of information: The One-Day Living Kidney Donor Assessment Clinic was developed after performing a comprehensive review of the literature, receiving feedback from patients who have successfully donated, and meetings with transplant program leadership from St. Joseph's Healthcare Hamilton. A multistakeholder team was formed that included health care staff from nephrology, transplant surgery, radiology, cardiology, social work, nuclear medicine, and patients with the prior lived experience of kidney donation. In the planning stages, the team met regularly to determine the objectives of the clinic, criteria for participation, clinic schedule, patient flow, and clinic metrics. Methods: Donor candidates entered the One-Day Clinic if they completed initial laboratory testing and agreed to an expedited process. If additional testing was required, it was completed on a different day. Donor candidates were reviewed by the nephrologist, transplant surgeon, and donor coordinator approximately 2 weeks after the clinic for final approval. The team continues to meet regularly to review donor feedback, discuss challenges, and brainstorm solutions. Key findings: The One-Day Clinic was implemented in March 2019, and has now been running for 4 years, making iterative improvements through continuous patient and provider feedback. To date, we have evaluated more than 150 donor candidates in this clinic. Feedback from donors has been uniformly positive (98% of donors stated they were very satisfied with the clinic), with most noting that the clinic was efficient and minimally impacted work and family obligations. Hospital leadership, including the health care professionals from each participating department, continue to show support and collaborate to create a seamless experience for donor candidates attending the One-Day Clinic. Limitations: Clinic spots are limited, meaning some interested donor candidates may not be able to enter a One-Day Clinic the same month they come forward. Implications: This patient-centered quality improvement intervention is designed to improve the efficiency and experience of the living kidney donor evaluation, result in better outcomes for kidney transplant recipients, and potentially increase living donation. Our next step is to conduct a formal evaluation of the clinic, measuring qualitative feedback from health care professionals working in the clinic and donor candidates attending the clinic, and measuring key process and outcome measures in donor candidates who completed the one-day assessment compared with those who underwent the usual care assessment. This program evaluation will provide reliable, regionally relevant evidence that will inform transplant centers across the country as they consider incorporating a similar one-day assessment model.

Objectifs du programme: Devenir donneur de rein vivant est difficile, le principal obstacle étant le processus d'évaluation inefficace auquel les candidats doivent se soumettre. Ce processus comporte plus de 30 examens (p. ex. tests de laboratoire et tests diagnostiques), questionnaires et consultations avec des spécialistes. Les candidats donneurs font plusieurs visites dans les hôpitaux et cliniques, et passent souvent plusieurs mois à attendre des rendez-vous et des résultats de tests. En Ontario (Canada), le délai médian pour l'évaluation d'un candidat au don est de près d'un an. Les temps d'attente plus longs sont associés à de moins bons résultats pour les receveurs d'une greffe rénale, ainsi qu'à des coûts de soins de santé plus élevés. Un processus d'évaluation plus court et plus efficace des donneurs potentiels permettrait à un plus grand nombre de patients atteints d'insuffisance rénale de recevoir une greffe, y compris une greffe préventive (c.-à-d. permettant d'éviter la dialyse). Cet article décrit une intervention d'amélioration de la qualité visant à augmenter l'efficience, l'efficacité et la personnalisation du processus d'évaluation des candidats au don. Nous avons développé une clinique d'un jour pour l'évaluation des donneurs de reins vivants (One-Day Living Kidney Donor Assessment Clinic), soit une clinique condensée où les candidats passent tous les tests et consultent un spécialiste dans la même journée. Sources de l'information: La clinique d'un jour pour l'évaluation des donneurs de reins vivants a été développée à la suite d'un examen approfondi de la littérature, de la consultation des commentaires de patients ayant donné avec succès et de rencontres avec les dirigeants du programme de transplantation du St Joseph's Healthcare d'Hamilton. Une équipe multipartite a été formée; celle-ci réunit du personnel soignant en néphrologie, chirurgie de transplantation, radiologie, cardiologie, travail social et médecine nucléaire, ainsi que des patients ayant une expérience vécue du don de rein. L'équipe s'est réunie régulièrement pendant les étapes de planification pour déterminer les objectifs, les paramètres et le calendrier de la clinique, ainsi que les critères de participation et le flux de patients. Méthodologie: Les donneurs potentiels qui avaient complété les tests de laboratoire initiaux et qui acceptaient de se soumettre à un processus accéléré ont été évalués à la clinique d'un jour. Si des tests supplémentaires étaient nécessaires, ceux-ci étaient effectués un autre jour. Les candidats ont été rencontrés par le néphrologue, le chirurgien de transplantation et le coordonnateur des dons environ deux semaines après leur visite à la clinique pour l'approbation finale. L'équipe multipartite continue de se réunir régulièrement pour examiner les commentaires des donneurs, discuter des défis et trouver des solutions. Principaux résultats: La clinique d'un jour, mise sur pied en mars 2019, est en activité depuis quatre ans et permet des améliorations itératives grâce à la rétroaction continue des patients et des soignants. À ce jour, plus de 150 candidats au don ont été évalués à la clinique. Les commentaires des donneurs sont quasi unanimement positifs (98 % des candidats ont déclaré être très satisfaits de la clinique), la plupart soulignant l'efficacité de la clinique et les conséquences minimes du processus sur les obligations professionnelles et familiales. La direction de l'hôpital, tout comme les professionnels de la santé des services participants, continue d'appuyer la clinique d'un jour et de collaborer à la création d'une expérience fluide pour les donneurs potentiels qui la fréquentent. Limites: Les places à la clinique sont limitées; ainsi, certains candidats au don d'un rein vivant pourraient ne pas pouvoir être admis dans le mois où ils se présentent à la clinique. Conclusion: Cette intervention d'amélioration de la qualité axée sur les patients est conçue pour augmenter l'efficacité du processus d'évaluation et bonifier l'expérience des donneurs de rein vivants. Elle vise également à améliorer les résultats des receveurs d'une greffe rénale et, potentiellement, augmenter le don vivant. La prochaine étape sera une évaluation formelle de la clinique, c'est-à-dire la mesure de la rétroaction qualitative des professionnels de la santé qui y travaillent et des candidats au don qui la fréquentent, et l'analyse des processus clés et des résultats des candidats évalués à la clinique d'un jour par rapport à ceux qui suivent le processus d'évaluation habituel. Cette évaluation du programme fournira des données probantes fiables et propres à la région qui pourront informer les centres de transplantation de tout le pays qui envisagent d'intégrer un processus d'évaluation similaire.

Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of increased aortic stiffness, is a risk factor for cardiovascular events and all-cause mortality in end-stage renal disease (ESRD). To minimize the deleterious effects of an increased aortic stiffness in ESRD patients, several interventions have been developed and cf-PWV has been used to monitor responses. OBJECTIVE: The aim of this study was to determine the effects of pharmacologic interventions that target aortic stiffness on cf-PWV and systolic blood pressure (SBP) in adults with ESRD. STUDY DESIGN: This study implements a systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM databases were searched. STUDY ELIGIBILITY PARTICIPANTS AND INTERVENTIONS: Randomized and non-randomized studies involving adults (>18 years) with ESRD of any duration, receiving or not renal replacement therapy (hemodialysis, peritoneal dialysis) and exposed to a pharmacologic intervention whose effects were assessed by cf-PWV. METHODS: Study screening, selection, data extraction, and quality assessments were performed by 2 independent reviewers. Narrative synthesis and quantitative data analysis summarized the review. RESULTS: We included 1027 ESRD participants from 13 randomized and 5 non-randomized studies. Most pharmacologic interventions targeted bone mineral metabolism disorder or hypertension. Treatment with vitamin D analogues or cinacalcet did not decrease cf-PWV or SBP over placebo or matched controls (P > .05). Calcium-channel blockers (CCB) decreased cf-PWV and SBP compared with placebo or standard care (P < .05). Renin-angiotensin system inhibitors did not show any advantage over placebo in decreasing cf-PWV (P > .05). LIMITATIONS: Quality of evidence ranged from very low to moderate. Overall evidence was limited by the low number of studies, small sample sizes, and methodological inconsistencies. CONCLUSIONS: Pharmacologic interventions targeting aortic stiffness in ESRD have mixed effects on reducing cf-PWV, with some strategies suggesting potential benefit. The quality of evidence, however, is insufficient to draw definitive conclusions on their use to slow progression of aortic stiffness in ESRD. Further well-designed studies are needed to confirm these associations and their impact on cardiovascular outcomes in ESRD.Registered in PROSPERO (CRD42016033463).

CONTEXTE: L'accroissement de la vitesse de l'onde de pouls carotido-fémorale (VOPcf), un substitut à l'accroissement de la rigidité aortique, constitue un facteur de risque d'événements cardiovasculaires et de mortalité toutes causes confondues en contexte d'insuffisance rénale terminale (IRT). Plusieurs interventions pharmacologiques ont été développées pour minimiser les effets délétères de l'accroissement de la rigidité aortique chez les patients atteints d'IRT, et la VOPcf a été employée pour en mesurer la réponse. OBJECTIF: Mesurer les effets d'interventions pharmacologiques ciblant la rigidité aortique sur la VOPcf et la pression systolique (PS) d'adultes atteints d'IRT. TYPE D'ÉTUDE: Revue systématique et méta-analyse. SOURCES: Les bases de données MEDLINE, EMBASE, Cochrane Central, EMB et du Service d'évaluation des technologies de la santé ont été consultées. ADMISSIBILITÉ PARTICIPANTS ET INTERVENTIONS: Ont été sélectionnées les études réparties aléatoirement ou non, peu importe leur durée, qui portaient sur des adultes atteints d'IRT, recevant ou non une thérapie de remplacement rénal (hémodialyse, dialyse péritonéale), qui avaient été exposés à une intervention pharmacologique dont les effets avaient été mesurés avec la VOPcf. MÉTHODOLOGIE: Deux réviseurs indépendants ont procédé à la recherche et à la sélection des études, à l'extraction des données et à l'évaluation de leur qualité. Une synthèse narrative et une analyse quantitative des données ont synthétisé les résultats de la revue. RÉSULTATS: L'étude porte sur un total de 1 027 sujets atteints d'IRT issus de 13 études à répartition aléatoire et de 5 études non réparties aléatoirement. La plupart des interventions pharmacologiques ciblaient l'hypertension ou un trouble du métabolisme de la densité osseuse. Lorsque comparés à un placebo ou à un témoin, les traitements impliquant un analogue de la vitamine D ou le cinacalcet n'ont eu aucun effet réducteur sur la VOPcf ou la PS (p>0,05). Les bloqueurs des canaux calciques ont montré un effet réducteur sur la VOPcf et la PS en comparaison du placebo ou du traitement standard (p<0,05). Les inhibiteurs du système rénine-angiotensine n'ont présenté aucun avantage pour réduire la VOPcf par rapport au placebo (p>0,05). LIMITES: La qualité des données recueillies variait de très pauvre à modérée. L'ensemble des données recueillies est limité par le faible nombre d'études, la petite taille des échantillons et par des divergences méthodologiques. CONCLUSION: Les interventions pharmacologiques ciblant la rigidité aortique en contexte d'IRT ont eu des résultats mitigés sur la réduction de la VOPcf, quoique certaines stratégies suggèrent de potentiels avantages. La qualité des données recueillies est toutefois insuffisante pour conclure de façon définitive que ces interventions ralentissent la progression de la rigidité aortique chez les patients atteints d'IRT. Des études bien conçues sont nécessaires pour confirmer ces associations et leur incidence sur les issues cardiovasculaires en contexte d'IRT.

A Systematic Review and Meta-analysis of Nonpharmacologic-based Interventions for Aortic Stiffness in End-Stage Renal Disease.

INTRODUCTION: Increased carotid-femoral pulse wave velocity (cf-PWV) in end-stage renal disease (ESRD) indicates enhanced aortic stiffness and mortality risk. We conducted a systematic review and meta-analysis of nonpharmacologic interventions in adults with ESRD to determine their effects on cf-PWV, systolic blood pressure (SBP), and intervention-associated adverse events. METHODS: MEDLINE, EMBASE, and EBM databases were searched. Study screening, selection, data collection, and methodological quality assessments were performed by 2 independent reviewers. Pooled-effect estimates from mean differences and 95% confidence intervals (CIs) were calculated using random effect models. RESULTS: A total of 2166 subjects with ESRD from 33 studies (17 randomized; 16 nonrandomized) were included. Four intervention-comparator pairs were meta-analyzed. Quality of evidence ranged from very low to moderate. Kidney transplantation decreased cf-PWV (-0.70 m/s; CI: -1.3 to -0.11; P = 0.02) and SBP (-8.3 mm Hg; CI: -13.2 to -3.3; P < 0.001) over pretransplantation. In randomized trials, control of fluid overload by bio-impedance reduced cf-PWV (-1.90 m/s; CI: -3.3 to -0.5); P = 0.02) and SBP (-4.3 mm Hg; CI: -7.7 to -0.93); P = 0.01) compared with clinical assessment alone. Cross-sectional studies also demonstrated significantly lower cf-PWV and SBP in normovolemia compared with hypervolemia (P ≤ 0.01). Low calcium dialysate decreased cf-PWV (-1.70 m/s; CI: -2.4 to -1.0; P < 0.00001) without affecting SBP (-1.6 mm Hg; CI: -8.9 to 5.8; P = 0.61). Intradialytic exercise compared with no exercise reduced cf-PWV (-1.13 m/s; CI: -2.2 to -0.03; P = 0.04), but not SBP (+0.5 mm Hg; CI: -9.5 to 10.4); P = 0.93). CONCLUSIONS: Several nonpharmacologic interventions effectively decrease aortic stiffness in ESRD. The impact of these interventions on cardiovascular outcomes and mortality risk reduction in ESRD requires further study.

A Survey of Training for Temporary Hemodialysis Catheter Insertion During Nephrology Fellowship in Canada: An Update.

BACKGROUND: Controversy exists as to whether the insertion of temporary hemodialysis catheters (THDCs) should remain a mandatory requirement of nephrology fellowship training in Canada. A survey conducted by our group in 2012 showed that many nephrology trainees reported inadequate training to achieve procedural competence. OBJECTIVE: To determine the current practices and training of the insertion of THDCs in nephrology fellowship programs in Canada and how this has evolved since 2012. DESIGN: A survey study was designed comprising the following sections: demographics, details regarding the number and types of THDCs inserted within the past 6 months of fellowship training, adherence to sterile techniques, the use of ultrasound guidance during THDC insertion, training for THDC insertion received before and during nephrology fellowship, and self-perceived adequacy of training and competence in THDC insertion. SETTING: The survey was distributed by e-mail in May 2018 either directly or through Canadian nephrology training programs. PARTICIPANTS: Current trainees of Canadian adult nephrology training programs. MEASUREMENTS: Descriptive statistics were used to analyze the summarized data. The means and interquartile ranges (IQRs) were used to summarize the number of THDC insertions performed, and the categorical data, including data on training and self-perceived competency, were reported using frequencies and percentages. A chi-squared test was used to evaluate the relationship between those who received simulation-based training and self-perceived confidence in either internal jugular or femoral catheter insertion. METHODS: An online survey, available in both English and French, was distributed to all adult nephrology trainees in Canada in May 2018 either directly or through their respective programs. RESULTS: Completed surveys were received from 46 of 136 nephrology trainees across Canada (34%). Of those who responded, the median (IQR) number of combined femoral and/or internal jugular THDCs inserted in the past 6 months of fellowship training was 3 (1-6). Eight respondents (17%) indicated that they had not inserted a THDC in the past 6 months. However, only 7 of 42 respondents (17%) indicated that they did not feel competent or adequately trained to perform either femoral or internal jugular THDC insertion. LIMITATIONS: Limitations of the study include participation of trainees at different stages of their training. Many trainees indicated that it was not a requirement to keep a formal log of their procedures performed and likely had recall bias when reporting their procedure details. CONCLUSIONS: Nephrology fellows in Canada are performing fewer THDC insertions compared to 2012 but report higher levels of self-perceived competence and better training. This may be as a result of significantly more simulation-based training. Our data suggest that training to procedural mastery using simulation-based techniques may be a path to ensuring adequate training for THDC insertion despite fewer procedures being performed during training.

CONTEXTE: Une controverse existe à savoir si l'insertion de cathéters d'hémodialyse temporaires (CHT) devrait demeurer une exigence de la formation des néphrologues au Canada. Une enquête menée par notre groupe en 2012 montrait que plusieurs stagiaires en néphrologie jugeaient leur formation insuffisante pour l'acquisition de compétences techniques. OBJECTIFS: Faire état des pratiques et de la formation actuelles en matière d'insertion de CHT dans les programs canadiens de stages en néphrologie, et témoigner de l'évolution de la situation depuis 2012. CONCEPTION DE L'ÉTUDE: L'étude, sous forme de sondage, a été conçue en incluant les éléments suivants: les données démographiques, les détails quant au nombre et au type de cathéters insérés au cours des six derniers mois de la formation, l'observance des techniques d'asepsie, le recours à l'échoguidage pendant la procédure, la formation reçue sur l'insertion de CHT avant et pendant le stage en néphrologie, et l'auto-évaluation de l'adéquation de la formation et des compétences individuelles en insertion de CHT. TYPE D'ÉTUDE: Un sondage distribué en mai 2018 par courrier électronique, directement ou par l'entremise des programs de formation en néphrologie. SUJETS: Les stagiaires actuels des programs canadiens de formation en néphrologie adulte. MESURES: Des statistiques descriptives ont été utilisées pour analyzer les données agrégées. Les moyennes et les écarts interquartiles (EIQ) ont été employés pour résumer le nombre d'insertions de CHT. Les données catégorielles, y compris les données sur la qualité de la formation et la compétence perçue, ont été rapportées en fréquences et en pourcentages. Enfin, un test x2 a évalué le lien entre la compétence individuelle perçue quant à l'insertion d'un cathéter dans la jugulaire interne ou dans la veine fémorale et le fait d'avoir ou non reçu une formation par simulation. MÉTHODOLOGIE: En mai 2018, un sondage électronique, disponible en anglais et en français, a été distribué à tous les stagiaires canadiens en néphrologie adulte, directement ou par l'intermédiaire de leurs programs respectifs. RÉSULTATS: Des 136 stagiaires ayant reçu le sondage, 46 (34%) l'ont retourné dument rempli. Le nombre médian combiné de CHT insérés dans la veine fémorale et/ou la jugulaire interne au cours des 6 derniers mois de formation était de 3 (EIQ: 1 à 6). Huit répondants (17%) n'avaient pas pratiqué cette procédure au cours des six derniers mois. Néanmoins, seulement 7 répondants sur un total de 42 (17%) ont indiqué ne pas se sentir à l'aise ou suffisamment formés pour pratiquer l'insertion d'un CHT dans la veine fémorale ou dans la jugulaire interne. LIMITES: L'étude porte sur des stagiaires à différentes étapes de leur formation. Aussi, plusieurs stagiaires ont indiqué qu'on ne les obligeait pas à tenir un registre officiel des procédures effectuées, leur déclaration pourrait donc présenter un biais de rappel. CONCLUSION: Les stagiaires en néphrologie canadiens pratiquent moins d'insertions de CHT, mais signalent une meilleure formation et des niveaux plus élevés de compétence perçue qu'en 2012, un constat qui pourrait s'expliquer par une formation axée sur la simulation de meilleure qualité. Ces résultats suggèrent que l'apprentissage de procédures par des techniques axées sur la simulation pourrait constituer un moyen d'assurer une formation adéquate en insertion de CHT, et ce, malgré le nombre réduit de procédures exécutées pendant la formation.

The impact of intervention strategies that target arterial stiffness in end-stage renal disease: a systematic review protocol.

BACKGROUND/OBJECTIVES: Vascular damage contributes to the high cardiovascular morbidity and mortality in end-stage renal disease (ESRD). Increased aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a strong and independent predictor of the cardiovascular risk in ESRD patients. Recently, there has been considerable interest in developing strategies to lessen the progression of arterial stiffness in ESRD patients using cf-PWV as a tool to monitor therapeutic responses, but their benefit on the long-term cardiovascular risk is not known. Appraisal of the effects of existing stiffness-based interventions on the cf-PWV would facilitate selecting optimal therapies to be tested in randomized clinical trials. The aim of this systematic review will be to evaluate the impact of arterial stiffness-based interventions on the cf-PWV in ESRD patients. Secondarily, for each intervention, we will determine the minimal duration needed to achieve a significant reduction of cf-PWV, the minimal cf-PWV reduction threshold or effect size, and adverse events. METHODS/DESIGN: This review will be conducted using MEDLINE, EMBASE, and EBM Reviews. We will select clinical trials and observational studies (cohort, case-control, and before/after studies and case series) that evaluated pharmacologic or non-pharmacologic interventions in which the primary effect is to improve structural and/or dynamic components of arterial stiffness in adults with stage 5 chronic kidney disease. The primary outcome of interest will be cf-PWV. Study selection and data collection will be performed by two reviewers. Validated tools will be used to assess the methodological quality and risk of bias among different study designs. We will describe all included citations according to study characteristics, methodological quality, and outcomes. Suitability for meta-analysis will be determined by the degree of clinical and statistical heterogeneity between studies. If appropriate, we will calculate effect estimates by obtaining the relative risks with 95 % confidence intervals pooled according to study design using a random effects model. DISCUSSION: This review will summarize evidence regarding effects of interventions targeting arterial stiffness in ESRD patients. Our results will inform clinicians and researchers on the type of existing arterial stiffness-based interventions for ESRD patients and their potential efficacy and safety, with a goal to guide future clinical trials aimed at reducing adverse cardiovascular events. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033463.