Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
BMJ Open. 2019 Sep 20;9(9):e030596. doi: 10.1136/bmjopen-2019-030596.
To evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.
Systematic review and meta-analysis.
Searching MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Clinical Trials Registry Platform, Health Technology Assessment, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index and Clinical Trials Register, from March 1999 to July 2018, we identified randomised controlled trials (RCTs) of drugs for hypertension, lipid modification, glycaemic control and sodium bicarbonate, compared with placebo, no drug or a drug from another class, in ≥40 adults with CKD stages 3 and/or 4, with at least 2 years of follow-up and reporting renal function (primary outcome), proteinuria, adverse events, maintenance dialysis, transplantation, cardiovascular events, cardiovascular mortality or all-cause mortality. Two reviewers independently screened citations and extracted data. For continuous outcomes, we used the ratio of means (ROM) at the end of the trial in random-effects meta-analyses. We assessed methodological quality with the Cochrane Risk of Bias Tool and confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
We included 35 RCTs and over 51 000 patients. Data were limited, and heterogeneity varied. Final renal function (estimated glomerular filtration rate) was 6% higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10, I=0%, low GRADE confidence) and 4% higher in those taking lipid-modifying drugs (ROM 1.04, 95% CI 1.00 to 1.08, I=88%, very low GRADE confidence). For RCTs of antihypertensive drugs, there were no significant differences in renal function. Treatment with lipid-modifying drugs led to a 36% reduction in cardiovascular disease and 26% reduction in all-cause mortality.
Glycaemic control and lipid-modifying drugs may slow the progression of CKD, but we found no pooled evidence of benefit nor harm from antihypertensive drugs. However, given the data limitations, further research is needed to confirm these findings.
CRD42015017501.
评估可能改变慢性肾脏病（CKD）3 期和 4 期成人疾病进展的药物干预措施的效果。
系统评价和荟萃分析。
检索 MEDLINE、EMBASE、疗效评价文摘数据库、 Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、国际临床试验注册平台、卫生技术评估、科学引文索引、社会科学引文索引、会议论文集引文索引和临床试验注册，时间从 1999 年 3 月至 2018 年 7 月，我们确定了高血压、血脂调节、血糖控制和碳酸氢钠的药物治疗的随机对照试验（RCT），与安慰剂、无药物或其他类别的药物相比，纳入了≥40 名 CKD 3 期和/或 4 期、至少随访 2 年且报告肾功能（主要结局）、蛋白尿、不良事件、维持性透析、移植、心血管事件、心血管死亡率或全因死亡率的成年人。两位审查员独立筛选引文并提取数据。对于连续结局，我们使用随机效应荟萃分析中试验结束时的均数比（ROM）。我们使用 Cochrane 偏倚风险工具评估方法学质量，并使用推荐评估、制定与评价（GRADE）框架评估证据的可信度。
我们纳入了 35 项 RCT 和超过 51000 名患者。数据有限，异质性变化。接受血糖控制药物治疗的患者终末肾功能（估算肾小球滤过率）高 6%（ROM 1.06，95%CI 1.02 至 1.10，I=0%，低 GRADE 可信度），接受血脂调节药物治疗的患者高 4%（ROM 1.04，95%CI 1.00 至 1.08，I=88%，非常低 GRADE 可信度）。对于降压药物的 RCT，肾功能无显著差异。血脂调节药物治疗可使心血管疾病减少 36%，全因死亡率减少 26%。
血糖控制和血脂调节药物可能会减缓 CKD 的进展，但我们没有发现降压药物有获益或有害的综合证据。然而，考虑到数据的局限性，需要进一步的研究来证实这些发现。
PROSPERO 注册号：CRD42015017501。
Zotero 插件
