Mehrotra Anita, Leung Wai-Yin, Joson Tannia
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1243, New York, NY, 10029, USA.
Syst Rev. 2015 Feb 21;4:13. doi: 10.1186/s13643-015-0002-x.
The prevalence of vitamin D deficiency in hemodialysis patients is high. While most hemodialysis patients are treated with activated vitamin D (1,25[OH]2D) to prevent renal osteodystrophy, clinical practices of the screening and treatment of 25(OH)2D deficiency are highly variable. It is unclear if nutritional vitamin D supplementation with D2 or D3 provides an additional clinical benefit beyond that provided by activated vitamin D treatment in this population.
METHODS/DESIGN: We will conduct a systematic review of nutritional vitamin D (D2/D3) supplementation and health-related outcomes in hemodialysis patients according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary objective is to assess the impact of nutritional vitamin D supplementation on clinical outcomes relevant in hemodialysis patients, such as mortality, cardiovascular events, infections, and fractures. Secondary outcomes will include anemia, hyperparathyroidism, medication use (erythrocyte-stimulating agents, activated vitamin D), and quality of life. We will search MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov for randomized, controlled trials of nutritional vitamin D supplementation (ergocalciferol/D2 or cholecalciferol/D3) in chronic hemodialysis patients. The Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies. We will perform meta-analyses using standard techniques for the outcomes listed above if pooling is deemed appropriate/sufficient. The results of this systematic review may highlight gaps in our knowledge of the relevance of nutritional vitamin D in end-stage renal disease, allowing for the informed design of clinical trials assessing the impact of nutritional vitamin D therapy in the hemodialysis population in the future.
PROSPERO CRD42014013931.
血液透析患者维生素D缺乏的患病率很高。虽然大多数血液透析患者接受活性维生素D（1,25[OH]2D）治疗以预防肾性骨营养不良，但25(OH)2D缺乏的筛查和治疗的临床实践差异很大。目前尚不清楚在该人群中，补充营养性维生素D2或D3是否能在活性维生素D治疗之外带来额外的临床益处。
方法/设计：我们将根据系统评价和Meta分析的首选报告项目（PRISMA）指南，对血液透析患者补充营养性维生素D（D2/D3）及其与健康相关的结局进行系统评价。主要目的是评估补充营养性维生素D对血液透析患者相关临床结局的影响，如死亡率、心血管事件、感染和骨折。次要结局将包括贫血、甲状旁腺功能亢进、药物使用（促红细胞生成剂、活性维生素D）和生活质量。我们将检索MEDLINE、Scopus、科学引文索引和ClinicalTrials.gov，以查找关于慢性血液透析患者补充营养性维生素D（麦角钙化醇/D2或胆钙化醇/D3）的随机对照试验。将使用Cochrane风险评估工具评估符合条件的研究的质量。如果认为合并是合适/充分的，我们将使用标准技术对上述结局进行Meta分析。该系统评价的结果可能会突出我们在终末期肾病中营养性维生素D相关性知识方面的空白，从而有助于未来设计评估营养性维生素D疗法对血液透析人群影响的临床试验。
PROSPERO CRD42014013931
