Qin Yuchen, Chen Tao, Chen Qi, Lv Jia Yi, Qi Na, Wu Cheng, He Jia
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Pharmacoepidemiol Drug Saf. 2016 May;25(5):503-11. doi: 10.1002/pds.3941. Epub 2016 Jan 19.
There has been much controversy over the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) on patients with renal dysfunction. The purpose of this study was to summarize the evidence regarding the effect of ACEIs/ARBs administration on mortality in patients with nondialysis-dependent chronic kidney disease (CKD) by using a meta-analytic approach.
We searched the PubMed, Embase, and Web of Science databases for studies on the effect of ACEIs/ARBs administration on mortality in patients with nondialysis-dependent CKD published before March 2015. Summary effect estimates with 95% confidence intervals were derived using the random-effects model, no matter whether the heterogeneity between the included studies was of statistical significance or not. Subgroup analyses, sensitivity analyses, and publication bias tests were performed.
Up to 25 March 2015, 10 cohort studies were included in this meta-analysis. The hazard risk of the association between ACEIs/ARBs administration and overall mortality was 0.83 (95% confidence interval 0.78-0.87) using a random-effects model with no heterogeneity (heterogeneity test I(2) = 43.8%, p = 0.067) and publication bias (Egger's test, p = 0.763). The subgroup was divided according to estimated glomerular filtration rate, duration of follow-up, Newcastle-Ottawa Scale star, and proportion of patients with common complications including heart failure, diabetes mellitus, and hypertension. Improved survival outcomes were observed in all subgroups analysis. Sensitivity analysis proved that overall estimated effect was robust.
This meta-analysis suggested that the use of ACEIs/ARBs in patients with nondialysis-dependent CKD was associated with improved survival. However, randomized studies are needed to confirm these findings and further establish causal relationship. Copyright © 2016 John Wiley & Sons, Ltd.
对于肾功能不全患者使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEIs/ARBs）一直存在诸多争议。本研究的目的是采用荟萃分析方法总结有关ACEIs/ARBs给药对非透析依赖型慢性肾脏病（CKD）患者死亡率影响的证据。
我们在PubMed、Embase和科学网数据库中检索了2015年3月之前发表的关于ACEIs/ARBs给药对非透析依赖型CKD患者死亡率影响的研究。无论纳入研究之间的异质性是否具有统计学意义，均使用随机效应模型得出95%置信区间的汇总效应估计值。进行了亚组分析、敏感性分析和发表偏倚检验。
截至2015年3月25日，本荟萃分析纳入了10项队列研究。使用无异质性（异质性检验I(2) = 43.8%，p = 0.067）和发表偏倚（Egger检验，p = 0.763）的随机效应模型，ACEIs/ARBs给药与总死亡率之间关联的风险比为0.83（95%置信区间0.78 - 0.87）。亚组根据估计的肾小球滤过率、随访时间、纽卡斯尔 - 渥太华量表星级以及包括心力衰竭、糖尿病和高血压在内的常见并发症患者比例进行划分。在所有亚组分析中均观察到生存结局得到改善。敏感性分析证明总体估计效应是稳健的。
本荟萃分析表明，在非透析依赖型CKD患者中使用ACEIs/ARBs与生存改善相关。然而，需要进行随机研究来证实这些发现并进一步建立因果关系。版权所有© 2016约翰威立父子有限公司。
Zotero 插件