Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease: A Systematic Review and Meta-analysis.
Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2023.10068
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发表时间：
2023-04-03
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
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静脉注射硫代硫酸钠 (STS) 治疗与患有钙化防御的慢性肾病 (CKD) 患者的皮肤病变改善和生存相关吗？这项荟萃分析对 19 项队列研究进行了检验，研究了对经历钙化防御的 CKD 患者进行 STS 治疗，结果并未显示与非 STS 组相比，静脉注射 STS 与皮肤病变改善或生存获益之间存在关联。这些结果表明，对经历钙防御的 CKD 患者进行静脉 STS 的研究并未发现皮肤病变结果或生存率有所改善。未来迫切需要严格评估应用于钙防御患者的治疗方法的研究。这项队列研究的荟萃分析回顾了硫代硫酸钠治疗与皮肤损伤和患有钙防御的慢性肾病患者的总体生存率之间的关系的最新结果。钙防御是一种罕见的高死亡率疾病，主要涉及慢性肾脏病（CKD）患者。硫代硫酸钠 (STS) 已被用作钙化防御的超适应证治疗药物，但缺乏临床试验和研究来证明其与未经 STS 治疗的治疗相比的效果。对队列研究进行荟萃分析，这些研究提供了比较接受和不接受静脉 STS 治疗的钙化防御患者的结果的数据。使用相关术语和同义词（包括硫代硫酸钠和 calci*）对 PubMed、Embase、Cochrane Library、Web of Science 和 ClinicalTrials.gov 进行搜索，没有语言限制。最初的搜索是在 2021 年 8 月 31 日之前发表的队列研究，其中包括被诊断患有 CKD 并经历钙化防御的成年患者，并且可以对接受和不接受静脉 STS 治疗的患者进行比较。如果研究仅报告非静脉注射 STS 的结果或未提供 CKD 患者的结果，则研究被排除。进行了随机效应模型。 Egger 检验用于衡量发表偏倚。使用 I2 检验评估异质性。皮肤病变改善和存活率，通过随机效应经验贝叶斯模型合成为比率数据。从目标数据库检索到的 5601 篇出版物中，有 19 项回顾性队列研究，包括 422 名患者（平均年龄 57 岁；37.3% 男性）符合资格标准。 STS 组和比较组之间在皮肤病变改善方面没有观察到差异（12 项研究，110 名患者；风险比，1.23；95% CI，0.85-1.78）。使用事件时间数据（涉及 269 名受试者的 3 项研究；风险比，0.82；95% CI，0.57-1.18），死亡风险（15 项研究，158 名患者；风险比，0.88；95% CI，0.70-1.10）和总生存率没有差异。在荟萃回归中，与 STS 相关的病变改善与发表年份呈负相关，这意味着与过去的研究相比，最近的研究更有可能报告零关联（系数 = −0.14；P = .008）。静脉注射 STS 与经历钙防御的 CKD 患者的皮肤病变改善或生存获益无关。未来的研究有必要检查钙化防御患者治疗的有效性和安全性。
Is intravenous sodium thiosulphate (STS) treatment associated with improvement in skin lesions and survival in patients with chronic kidney disease (CKD) experiencing calciphylaxis? This meta-analysis of 19 cohort studies examining STS treatment for patients with CKD experiencing calciphylaxis did not show an association between intravenous STS and skin lesion improvement or survival benefits compared with non-STS group. These results suggest that studies of intravenous STS on patients with CKD experiencing calciphylaxis have not found an improvement in skin lesion outcomes or survival. Future studies that rigorously evaluate therapies applied to patients with calciphylaxis are urgently needed. This meta-analysis of cohort studies reviews current results for the association of sodium thiosulphate treatment with skin lesions and overall survival of patients with chronic kidney disease who contract calciphylaxis. Calciphylaxis is a rare disease with high mortality mainly involving patients with chronic kidney disease (CKD). Sodium thiosulphate (STS) has been used as an off-label therapeutic in calciphylaxis, but there is a lack of clinical trials and studies that demonstrate its effect compared with those without STS treatment. To perform a meta-analysis of the cohort studies that provided data comparing outcomes among patients with calciphylaxis treated with and without intravenous STS. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using relevant terms and synonyms including sodium thiosulphate and calci* without language restriction. The initial search was for cohort studies published before August 31, 2021, that included adult patients diagnosed with CKD experiencing calciphylaxis and could provide a comparison between patients treated with and without intravenous STS. Studies were excluded if they reported outcomes only from nonintravenous administration of STS or if the outcomes for CKD patients were not provided. Random-effects models were performed. The Egger test was used to measure publication bias. Heterogeneity was assessed using the I2 test. Skin lesion improvement and survival, synthesized as ratio data by a random-effects empirical Bayes model. Among the 5601 publications retrieved from the targeted databases, 19 retrospective cohort studies including 422 patients (mean age, 57 years; 37.3% male) met the eligibility criteria. No difference was observed in skin lesion improvement (12 studies with 110 patients; risk ratio, 1.23; 95% CI, 0.85-1.78) between the STS and the comparator groups. No difference was noted for the risk of death (15 studies with 158 patients; risk ratio, 0.88; 95% CI, 0.70-1.10) and overall survival using time-to-event data (3 studies with 269 participants; hazard ratio, 0.82; 95% CI, 0.57-1.18). In meta-regression, lesion improvement associated with STS negatively correlated with publication year, implying that recent studies are more likely to report a null association compared with past studies (coefficient = −0.14; P = .008). Intravenous STS was not associated with skin lesion improvement or survival benefit in patients with CKD experiencing calciphylaxis. Future investigations are warranted to examine the efficacy and safety of therapies for patients with calciphylaxis.
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DOI：
10.1016/j.jccw.2016.08.004
发表时间：
2015-12-01
期刊：
The journal of the American College of Clinical Wound Specialists
影响因子：
--
作者：
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通讯作者：
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DOI：
10.2215/cjn.09880912
发表时间：
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影响因子：
9.8
作者：
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通讯作者：
Lacson, Eduardo, Jr.
影响因子：
1
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Honda, Hirokazu
影响因子：
2.1
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影响因子：
13.2
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Spector, DA