title: Con: Meta-analysis: some key limitations and potential solutions.
abstract: Meta-analysis, a statistical combination of results of several trials to produce a summary effect, has been subject to criticism in the past, mainly for the reasons of poor quality of included studies, heterogeneity between studies meta-analyzed and failing to address publication bias. These limitations can cause the results to be misleading, which is important if policy and practice decisions are based on systematic reviews and meta-analyses. We elaborate on these limitations and illustrate them with examples from the nephrology literature. Finally, we present some potential solutions, notably, education in meta-analysis for evidence producers and consumers as well as the use of individual patient data for meta-analyses.
authors.affiliation: Centre for Evidence-Based Health Care, Department of Interdisciplinary Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Esterhuizen
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada Department of Anesthesia, McMaster University, Hamilton, ON, Canada Department of Pediatrics, McMaster University, Hamilton, ON, Canada Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods*; D003657:Decision Making; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D010820:Physicians / Q000639:trends*; D012196:Review Literature as Topic
keywords: evidence-based medicine; heterogeneity; limitations; meta-analysis; publication bias