Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis
Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis
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DOI：
10.1155/2019/1925243
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发表时间：
2019-01-01
影响因子：
--
通讯作者：
Liang, Min
中科院分区：
文献类型：
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作者：
Li, Yan;Xie, Na;Liang, Min
背景和目的。心血管疾病是透析患者死亡的主要原因。虽然醛固酮拮抗剂被认为是治疗严重心力衰竭患者以降低心源性死亡率的一种治疗方法，但使用醛固酮拮抗剂治疗接受维持性透析的患者是否可以降低心脑血管（CCV）的风险仍不清楚。我们的目的是系统地评估在常规治疗基础上加用醛固酮拮抗剂对维持性透析患者的疗效和耐受性。材料和方法。我们检索了PubMed、EMBASE、科克伦图书馆、中国生物医学文献数据库（CBM）和中国知网（CNKI）中的相关文章。关注的主要终点是CCV死亡率。次要终点为全因死亡率、左心室质量指数（LVMI）和左心室射血分数（LVEF）。采用漏斗图和Egger检验评价发表偏倚。使用Review Manager软件版本5.3进行荟萃分析。结果该分析包括10项随机对照试验（RCT），共1172例慢性透析患者。在透析人群中使用醛固酮拮抗剂导致CCV死亡率（RR 0.42，95%CI 0.26-0.65，P=0.0002）和全因死亡率（RR 0.46，95%CI 0.32-0.66，P =0.0002）显著降低。
Background and Purpose. Cardiovascular disease is the major cause of death in dialysis patients. Although aldosterone antagonists were considered a treatment for severe heart failure patients to reduce cardiac mortality, whether treating patients undergoing maintenance dialysis with aldosterone antagonists could reduce the risk of cardiocerebrovascular (CCV) remains unclear. We aim to systematically assess the efficacy and tolerability of the addition of aldosterone antagonists to conventional therapy in patients undergoing maintenance dialysis. Materials and Methods. We searched PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database (CBM), and the China National Knowledge Infrastructure (CNKI) for relevant articles. The primary endpoint of interest was CCV mortality. The secondary endpoints were all-cause mortality, left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF). Publication bias was evaluated using funnel plots and Egger's test. The meta-analysis was performed using Review Manager software version 5.3. Results. This analysis included 10 randomized controlled trials (RCTs) with 1172 total chronic dialysis patients. The use of aldosterone antagonists in the dialysis population resulted in a marked reduction in CCV mortality (RR 0.42, 95% CI 0.26-0.65, P=0.0002) and all-cause mortality (RR0.46, 95%CI 0.32-0.66, P