Webster Emma R, Perkovic Adam, Neuen Brendon L, Tuttle Katherine R, Perkovic Vlado
The Children's Hospital at Westmead, Sydney, NSW, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Clin Kidney J. 2025 Jan 14;18(3):sfaf001. doi: 10.1093/ckj/sfaf001. eCollection 2025 Mar.
Chronic kidney disease (CKD) is characterized by chronic inflammation, which is strongly linked to risk of cardiovascular disease. Anti-inflammatory agents present a novel strategy to reduce the burden of cardiovascular disease in people with CKD, but their effects on clinical outcomes are uncertain.
A systematic review and meta-analysis was performed to assess the efficacy and safety of anti-inflammatory agents in CKD (PROSPERO CRD42021238755). Medline, Embase and Cochrane databases were searched up to 8 October 2024 for randomized controlled trials of anti-inflammatory agents in CKD with at least 100 patient-years follow-up per treatment arm. The primary study outcome was major adverse cardiovascular events (MACE; defined as myocardial infarction, stroke or cardiovascular death). Other outcomes included CKD progression, malignancy and infection.
Nine trials of 12 042 participants and six different anti-inflammatory classes were identified. Overall, anti-inflammatory agents did not reduce the risk of MACE [risk ratio (RR) 1.01, 95% confidence interval (CI) 0.81-1.24], although there was significant heterogeneity across studies (-heterogeneity = .001; I = 72%). Anti-inflammatory agents did not have a clear effect on the composite kidney outcome (RR 0.82, 95% CI 0.55-1.22), although there were few events and some trials suggested improvements in the rate of decline in kidney function. Infections were increased with anti-inflammatory agents compared with placebo (RR 1.35, 95% CI 1.01-1.82).
There is currently insufficient evidence to support the use of anti-inflammatory agents to reduce cardiovascular risk or CKD progression in people with CKD, and further dedicated studies in this population are warranted. The potential increased risk of infection with anti-inflammatory agents is an important consideration in the evaluation of these therapies in CKD.
慢性肾脏病（CKD）的特征是慢性炎症，这与心血管疾病风险密切相关。抗炎药物为减轻CKD患者的心血管疾病负担提供了一种新策略，但其对临床结局的影响尚不确定。
进行了一项系统评价和荟萃分析，以评估抗炎药物在CKD中的疗效和安全性（国际前瞻性系统评价注册库CRD42021238755）。截至2024年10月8日，检索了Medline、Embase和Cochrane数据库，以查找CKD中抗炎药物的随机对照试验，每个治疗组至少有100患者年的随访。主要研究结局是主要不良心血管事件（MACE；定义为心肌梗死、中风或心血管死亡）。其他结局包括CKD进展、恶性肿瘤和感染。
确定了9项试验，共12042名参与者，涉及6种不同的抗炎药物类别。总体而言，抗炎药物并未降低MACE风险[风险比（RR）1.01，95%置信区间（CI）0.81-1.24]，尽管各研究间存在显著异质性（异质性检验P值=0.001；I²=72%）。抗炎药物对综合肾脏结局没有明确影响（RR 0.82，95%CI 0.55-1.22），尽管事件较少，且一些试验表明肾功能下降速率有所改善。与安慰剂相比，抗炎药物会增加感染风险（RR 1.35，95%CI 1.01-1.82）。
目前尚无足够证据支持使用抗炎药物降低CKD患者的心血管风险或CKD进展，因此有必要在该人群中开展进一步的专门研究。在评估这些疗法在CKD中的应用时，抗炎药物潜在增加的感染风险是一个重要考虑因素。
Zotero 插件
