Effect of active vitamin D on cardiovascular outcomes in predialysis chronic kidney diseases: A systematic review and meta-analysis
Effect of active vitamin D on cardiovascular outcomes in predialysis chronic kidney diseases: A systematic review and meta-analysis
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DOI：
10.1111/nep.12505
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发表时间：
2015-10-01
期刊：
影响因子：
2.5
通讯作者：
Liao, Yun-Hua
中科院分区：
文献类型：
--
作者：
Li, Xiao-Hua;Feng, Li;Liao, Yun-Hua
目的维生素D缺乏的患者患心血管疾病的风险增加。方法检索Pubmed、Embase、Cochrane图书馆、中国期刊全文数据库、中国期刊网、中国期刊全文数据库、中国期刊网、中国期刊全文数据库、中国期刊网、中国期刊全文数据库、中国期刊全文数据库、中国使用符合系统审查和荟萃分析(PRISMA)准则的首选报告项目的标准方法进行荟萃分析。审阅者管理器软件，版本结果共纳入7项随机对照试验(其中5项研究为甲钙化醇，2项研究为骨化三醇，共731例患者)。与对照组相比，活性维生素D降低了心血管事件的发生率(RR，0.27；95%CI，0.13-0.59)，增加了蛋白尿组(RR，1.9；95%CI，1.34-2.71)，但对左室重量指数和收缩功能无明显影响(MD，0.42g/m(2.7)；95%CI，-0.23-1.07g/m(2.7)，左室重量指数和MD，P=0.21，-0.33；左心室射血分数95%可信区间为-0.74~0.07，P=0.1)。活性维生素D对收缩压和舒张压均无降低作用(MD，0.3 mm Hg；95%CI，-4.95-5.56 mm Hg；MD，-0.24 mm Hg；95%CI：-6.21-5.72 mm Hg)。治疗后高血钙症的发生率增加(RR，7.85；95%CI，2.92~21.10)。结论活性维生素D可减少心血管事件的发生，减少蛋白尿，但其对心脏结构和功能的长期影响有待进一步证实。高钙血症发生的可能性增加。综述：这篇文章分析和回顾了积极的维生素D治疗在透析前慢性肾脏病患者中降低心血管事件发生率和减少蛋白尿的能力。然而，其对心脏结构和功能的长期影响还有待进一步证实。
AimVitamin D deficient patients present an increased risk of cardiovascular disease. We conducted this systematic review and meta-analysis to evaluate the effect of active vitamin D analogue on cardiovascular outcomes in predialysis chronic kidney disease.MethodsPubmed, Embase, the Cochrane Library, CNKI, and article reference lists were searched for randomized controlled trials (RCTs) that compared active vitamin D analogues with placebo or no treatment for patients with predialysis chronic kidney disease. A meta-analysis was conducted using the standard methods consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewer Manager Software, ver. 5.2, was used.ResultsSeven RCTs (five studies with paricalcitol and two studies with calcitriol, 731 patients) were included. Compared with control groups, active vitamin D reduced the incidence of cardiovascular events (RR, 0.27; 95% CI, 0.13-0.59), induced an increase in those with proteinuria reduction (RR, 1.9; 95% CI, 1.34-2.71), but did not alter left ventricular mass index and systolic function (MD, 0.42g/m(2.7); 95% CI, -0.23-1.07g/m(2.7), P=0.21 for left ventricular mass index and MD, -0.33; 95% CI, -0.74-0.07, P=0.1 for left ventricular ejection fraction). Neither systolic blood pressure nor diastolic blood pressure was reduced by active vitamin D (MD, 0.3mmHg; 95% CI, -4.95-5.56mmHg; MD, -0.24mmHg; 95% CI: -6.21-5.72mmHg, respectively). Increased probability of hypercalcaemia after paricalcitol therapy was found (RR, 7.85; 95% CI, 2.92-21.10).ConclusionActive vitamin D reduced the incidence of cardiovascular events and induced a reduction in proteinuria, but its long-term effect on cardiac structure and function needed further confirmation. Increased probability of hypercalcaemia after paricalcitol therapy was found.Summary at a Glance This manuscript analyzes and reviews the ability of acitve Vitamin D treatment to reduce incidence of cardiovascular events and reduce proteinuria in pre-dialysis CKD patients. However, its long-term effect on cardiac structure and function needs further confirmation.