Appendix B

PICOS for literature search, search strategies & PRISMA flowchart

PICOS

Eligibility Criteria:

Population: Adults, children and young people receiving dialysis (haemodialysis, haemodiafiltration and peritoneal dialysis) for end stage renal disease

Intervention:

• Any intervention intended to reduce blood pressure (BP), to include but not limited to: blood pressure lowering medication; target/dry weight reduction or optimization; dialysis prescription, including ultrafiltration volumes, ultrafiltration rate; diet, including salt restriction; exercise or other lifestyle intervention; self-management techniques.
• Any intervention intended to mitigate intradialytic hypotension (IDH) or other hypotensive episodes, including low temperature dialysis, ultrafiltration profiling, dialysate sodium concentration and profiling, midodrine use.

Comparison: Any trial that compares one or more interventions intended to reduce BP and/or to mitigate IDH or other hypotensive episodes in people receiving dialysis, including trials that compare an intervention with placebo or standard of care.

Outcomes: All-cause mortality; CV events (including, but not limited to, myocardial infarction, unstable angina, stroke/TIA, admission for heart failure, PVD events); BP reductions; IDH; vascular access thrombosis; post-dialysis recovery time; injurious falls, fractures; hospitalization for any cause; medication adherence; patient reported outcomes; residual renal function; intra-dialytic weight gain; left ventricular hypertrophy, carotid intima media thickness, aortic pulse wave velocity.

Studies: Clinical trials; Meta-analyses; Systematic reviews; Trial protocols; Conference proceedings/abstracts; Unpublished literature / grey literature

In the knowledge that clinical trials on this topic are limited, we will also include: observational and qualitative studies that have population and/or outcomes as described above, and where the primary focus of the study is at least one of:

• BP measurement techniques
• Relationship between BP and outcomes above
• Patient and/or carer perspectives, experience, knowledge in relation to strategies to manage BP

Exclusion Criteria:

The search strategy will eliminate studies solely focusing on:

• Acute haemodialysis
• Acute peritoneal dialysis
• Continuous veno-venous haemofiltration (CVVHF) and other acute renal replacement modalities
• Hypertension in any specialised vascular bed (e.g. pulmonary, intracranial)

Search Strategies

PubMed

((“end stage” OR chronic) AND (kidney OR renal) AND (disease OR failure))

AND

(dialysis OR haemodialysis OR haemodiafiltration OR “peritoneal dialysis”))

AND

((hypertension OR hypotension OR “blood pressure” AND (medication OR reduc* OR optimiz* OR optimis* OR lower* OR (ultrafiltration AND (volum* OR rate)) OR diet OR (salt AND (reduction OR restriction OR limiting)) OR exercise OR lifestyle OR self-management)) OR (“intradialytic hypotension” OR IDH OR “hypotensive episod*” OR “low temperature dialysis” OR “ultrafiltration profiling” OR (“dialysate sodium” AND (concentrat* OR profil*)) OR midodrine))

AND

(“all cause mortality” OR cardiovascular OR “myocardial infarction” OR “unstable angina” OR stroke OR TIA OR “heart failure” OR PVD OR “vascular access thrombosis” OR “post-dialysis recovery time” OR fall* OR hospitalisation OR hospitalization OR adherence OR “patient reported outcom*” OR PROM OR “residual renal function” OR “intra-dialytic weight gain” OR “left ventricular hypertrophy” OR “carotid intima media thickness” OR “aortic pulse wave velocity”)

Filters: Clinical Study, Clinical Trial, Clinical Trial, Phase II, Clinical Trial, Phase III, Clinical Trial, Phase IV, Comparative Study, Controlled Clinical Trial, Evaluation Study, Meta-Analysis, Multicenter Study, Observational Study, Pragmatic Clinical Trial, Randomized Controlled Trial, Review, Systematic Review, from 1/1/2000 to 31/12/2022

Embase

1. exp end stage renal disease/
2. ((“end stage” or chronic) and (kidney or renal) and (disease or failure)).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]
3. 1 or 2
4. exp dialysis/
5. exp hemodialys/
6. (dialysis or haemodialysis or haemodiafiltration or (peritoneal and dialysis)).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]
7. 4 or 5 or 6
8. exp hypotension/ or exp hypertension/

9. (blood pressure and (medication or reduc$ or optimiz$ or optimis$ or lower$)).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word

10. (ultrafiltration and (volum$ or rate)).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

11. (diet or (salt and (reduction or restriction or limiting))).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

12. (exercise or lifestyle or self-management).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

13. (intradialytic hypotension or IDH or hypotensive episod* or low temperature dialysis or ultrafiltration profiling or (dialysate sodium and (concentrat$ or profil$)) or midodrine).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

14. 9 or 10 or 11 or 12 or 13

15. 8 and 14

16. (all cause mortality or cardiovascular or myocardial infarction or unstable angina or stroke or TIA or heart failure or PVD or vascular access thrombosis or post-dialysis recovery time or fall$ or hospitalisation or hospitalization or adherence or patient reported outcom$ or PROM or residual renal function or intra-dialytic weight gain or left ventricular hypertrophy or carotid intima media thickness or aortic pulse wave velocity).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

17. 3 and 7 and 15 and 16

18. limit 17 to yr=”2000 -Current”

19. (“randomi$ed controlled trial” or RCT or “controlled clinical trial” or “systematic review” or “meta-analysis”).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word]

20. exp randomized controlled trial/

21. exp meta analysis/

22. exp “systematic review”/

23. 19 or 20 or 21 or 22

24. 18 and 23

Cochrane

#1 MeSH descriptor: [Kidney Failure, Chronic] explode all trees

#2 (“end stage” or chronic) and (kidney or renal) and (disease or failure):ti,ab,kw

#3 #1 OR #2

#4 MeSH descriptor: [Dialysis] explode all trees

#5 MeSH descriptor: [Renal Dialysis] explode all trees

#6 dialysis or haemodialysis or haemodiafiltration or (peritoneal and dialysis):ti,ab,kw

#7 #4 OR #5 OR #6

#8 MeSH descriptor: [Hypotension] explode all trees

#9 blood pressure and (medication or reduc$ or optimiz$ or optimis$ or lower$):ti,ab,kw

#10 ultrafiltration and (volum$ or rate):ti,ab,kw

#11 diet or (salt and (reduction or restriction or limiting)):ti,ab,kw

#12 (exercise or lifestyle or self-management):ti,ab,kw

#13 (intradialytic hypotension or IDH or hypotensive episod* or low temperature dialysis or ultrafiltration profiling or (dialysate sodium and (concentrat$ or profil$)) or midodrine):ti,ab,kw

#14 #9 OR #10 OR #11 OR #12 OR #13

#15 #8 AND #14

#16 (all-cause mortality or cardiovascular or myocardial infarction or unstable angina or stroke or TIA or heart failure or PVD or vascular access thrombosis or post-dialysis recovery time or fall$ or hospitalisation or hospitalization or adherence or patient reported outcom$ or PROM or residual renal function or intra-dialytic weight gain or left ventricular hypertrophy or carotid intima media thickness or aortic pulse wave velocity):ti,ab,kw

#17 #3 AND #7 AND #15 AND #16 with Publication Year from 2000 to 2022, in Trials

CINAHL

S1 (MH “Kidney Failure, Chronic+”)

S2 (kidney OR renal) AND (end stage OR chronic) AND (failure OR disease OR injury)

S3 S1 OR S2

S4 (MH “Hemodialysis+”) OR (MH “Dialysis+”)

S5 dialysis OR haemodialysis OR haemodiafiltration OR “peritoneal dialysis”

S6 S4 OR S5

S7 ((“blood pressure” AND (medication OR reduc* OR optimiz* OR optimis* OR lower* OR (ultrafiltration AND (volum* OR rate)) OR diet OR (salt AND (reduction OR restriction OR limiting)) OR exercise OR lifestyle OR self- management)) OR (“intradialytic hypotension” OR IDH OR “hypotensive episod*” OR “low temperature dialysis” OR “ultrafiltration profiling” OR (“dialysate sodium” AND (concentrat* OR profil*)) OR midodrine))

S8 (MH “Hypotension”)

S9 S7 OR S8

S10 (“all cause mortality” OR cardiovascular OR “myocardial infarction” OR “unstable angina” OR stroke OR TIA OR “heart failure” OR PVD OR “vascular access thrombosis” OR “post- dialysis recovery time” OR fall* OR hospitalisation OR hospitalization OR adherence OR “patient reported outcom*” OR PROM OR “residual renal function” OR “intra- dialytic weight gain” OR “left ventricular hypertrophy” OR “carotid intima media thickness” OR “aortic pulse wave velocity”)

S11 S3 AND S6 AND S9 AND S10, Limiters – Published Date: 20020101-20221231

Medline

1. exp Renal Insufficiency, Chronic/
2. ((“end stage” or chronic) and (kidney or renal) and (disease or failure)).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
3. 1 or 2
4. exp Dialysis/
5. exp Renal Dialysis/
6. (dialysis or haemodialysis or haemodiafiltration or (peritoneal and dialysis)).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
7. 4 or 5 or 6
8. exp Hypotension/
9. (blood pressure and (medication or reduc$ or optimiz$ or optimis$ or lower$)).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
10. (ultrafiltration and (volum$ or rate)).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
11. (diet or (salt and (reduction or restricting or limiting))).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
12. (exercise or lifestyle or self-management).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
13. (intradialytic hypotension or IDH or hypotensive episod$ or low temperature dialysis or ultrafiltration profiling or (dialysate sodium and (concentrat$ or profil$)) or midodrine).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
14. 9 or 10 or 11 or 12 or 13
15. 8 and 14
16. (all cause mortality or cardiovascular or myocardial infarction or unstable angina or stroke or TIA or heart failure or PVD or vascular access thrombosis or post-dialysis recovery time or fall$ or hospitalisation or hospitalization or adherence or patient reported outcom$ or PROM or residual renal function or intra-dialytic weight gain or left ventricular hypertrophy or carotid intima media thickness or aortic pulse wave velocity).mp. [mp=title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms, population supplementary concept word, anatomy supplementary concept word]
17. 3 and 7 and 15 and 16
18. limit 17 to yr=”2000 – Current”