Liao Guangzhi, Wang Xiangpeng, Li Yiming, Chen Xuefeng, Huang Ke, Bai Lin, Ye Yuyang, Peng Yong
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China.
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China.
Pharmaceutics. 2022 Dec 20;15(1):6. doi: 10.3390/pharmaceutics15010006.
The benefits and safety of antidyslipidemia pharmacotherapy in patients with chronic kidney disease were not well defined so the latest evidence was summarized by this work.
This systematic review and Bayesian network meta-analysis (NMA) included searches of PubMed, Embase, and Cochrane Library from inception to 28 February 2022, for randomized controlled trials of any antilipidaemic medications administered to adults with chronic kidney disease [CKD: defined as estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m not undergoing transplantation], using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the certainty of the evidence.
55 trials and 30 works of them were included in our systematic review and NMA, respectively. In comparisons with no antidyslipidemia therapy or placebo, proprotein convertase subtilisin/Kexin type 9 inhibitors plus statin (PS) was the most effective drug regimen for reducing all-cause mortality (OR 0.62, 95% CI [0.40, 0.93]; GRADE: moderate), followed by moderate-high intensity statin (HS, OR 0.76, 95% CI [0.60, 0.93]; I = 66.9%; GRADE: moderate). PS, HS, low-moderate statin (LS), ezetimibe plus statin (ES), and fibrates (F) significantly decreased the composite cardiovascular events. The subgroup analysis revealed the null effect of statins on death (OR 0.92, 95% CI [0.81, 1.04]) and composite cardiovascular events (OR 0.94, 95% CI [0.82, 1.07]) in dialysis patients.
In nondialysis CKD patients, statin-based therapies could significantly and safely reduce all-cause death and major composite cardiovascular events despite the presence of arteriosclerotic cardiovascular disease and LDL-c levels. Aggressive medication regimens, PS and HS, appeared to be more effective, especially in patients with established CAD.
慢性肾脏病患者抗血脂异常药物治疗的益处和安全性尚不明确，因此本研究总结了最新证据。
本系统评价和贝叶斯网络荟萃分析（NMA）检索了从创刊至2022年2月28日的PubMed、Embase和Cochrane图书馆，纳入了对患有慢性肾脏病（CKD：定义为估计肾小球滤过率（eGFR）≤60 mL/min/1.73 m²且未接受移植的成年人）使用任何抗血脂药物的随机对照试验，使用推荐评估、制定和评价（GRADE）工具评估证据的确定性。
我们的系统评价和NMA分别纳入了55项试验和其中30项研究。与不进行抗血脂异常治疗或使用安慰剂相比，前蛋白转化酶枯草溶菌素/kexin 9型抑制剂加他汀类药物（PS）是降低全因死亡率最有效的药物方案（OR 0.62，95%CI[0.40，0.93]；GRADE：中等），其次是中高强度他汀类药物（HS，OR 0.76，95%CI[0.60，0.93]；I² = 66.9%；GRADE：中等）。PS、HS、低中强度他汀类药物（LS）、依折麦布加他汀类药物（ES）和贝特类药物（F）显著降低了复合心血管事件。亚组分析显示，他汀类药物对透析患者的死亡（OR 0.92，95%CI[0.81，1.04]）和复合心血管事件（OR 0.94，95%CI[0.82，1.07]）无影响。
在非透析CKD患者中，尽管存在动脉粥样硬化性心血管疾病和低密度脂蛋白胆固醇水平，基于他汀类药物的治疗可显著且安全地降低全因死亡和主要复合心血管事件。积极的药物方案，如PS和HS，似乎更有效，尤其是在已确诊CAD的患者中。
