Division of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
Division of Nephrology, Shanxi Cardiovascular Hospital, Taiyuan, China.
Ren Fail. 2022 Dec;44(1):106-115. doi: 10.1080/0886022X.2021.2023023.
Metabolic acidosis accelerates the progression of chronic kidney disease (CKD) and increases the mortality rate. Whether oral alkali drug therapy benefits pre-dialysis CKD patients is controversial. We performed a meta-analysis of the effects of oral alkali drug therapy on major clinical outcomes in pre-dialysis CKD patients.
We systematically searched MEDLINE using the Ovid, EMBASE, and Cochrane Library databases without language restriction. We included all eligible clinical studies that involved pre-dialysis CKD adults and compared those who received oral alkali drug therapy with controls.
A total of 18 eligible studies, including 14 randomized controlled trials and 4 cohort studies reported in 19 publications with 3695 participants, were included. Oral alkali drug therapy led to a 55% reduction in renal failure events (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.25-0.82), a rate of decline in the estimated glomerular filtration rate (eGFR) of 2.59 mL/min/1.73 m per year (95% CI, 0.88-4.31). There was no significant effect on decline in eGFR events (RR: 0.34; 95% CI: 0.09-1.23), proteinuria (standardized mean difference: -0.32; 95% CI: -1.08 to 0.43), all-cause mortality events (RR: 0.90; 95% CI: 0.40-2.02) and cardiovascular (CV) events (RR: 1.03; 95% CI: 0.32-3.37) compared with the control groups.
Based on the available and low-to-moderate certainty evidence, oral alkali drug therapy might potentially reduce the risk of kidney failure events, but no benefit in reducing all-cause mortality events, CV events, decline in eGFR and porteninuria.
代谢性酸中毒会加速慢性肾脏病（CKD）的进展并增加死亡率。口服碱剂治疗是否有益于透析前 CKD 患者存在争议。我们对口服碱剂治疗对透析前 CKD 患者主要临床结局的影响进行了荟萃分析。
我们系统地检索了 MEDLINE 使用 Ovid、EMBASE 和 Cochrane 图书馆数据库，没有语言限制。我们纳入了所有涉及透析前 CKD 成人的合格临床研究，并将接受口服碱剂治疗的患者与对照组进行了比较。
共有 18 项合格研究，包括 14 项随机对照试验和 4 项队列研究，发表于 19 篇文献中，共有 3695 名参与者。口服碱剂治疗可使肾衰竭事件减少 55%（相对风险 [RR]：0.45；95%置信区间 [CI]：0.25-0.82），估计肾小球滤过率（eGFR）的下降速度为每年 2.59 mL/min/1.73 m（95%CI：0.88-4.31）。对 eGFR 下降事件（RR：0.34；95% CI：0.09-1.23）、蛋白尿（标准化均数差：-0.32；95% CI：-1.08 至 0.43）、全因死亡率事件（RR：0.90；95% CI：0.40-2.02）和心血管（CV）事件（RR：1.03；95% CI：0.32-3.37）的影响与对照组相比无显著差异。
根据现有证据，且证据质量为低到中等，口服碱剂治疗可能降低肾衰竭事件的风险，但不能降低全因死亡率事件、CV 事件、eGFR 下降和蛋白尿。
