Antihypertensive treatments in adult autosomal dominant polycystic kidney disease: network meta-analysis of the randomized controlled trials.
Antihypertensive treatments in adult autosomal dominant polycystic kidney disease: network meta-analysis of the randomized controlled trials.
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成人常染色体显性多囊肾病的抗高血压治疗：随机对照试验的网络荟萃分析
DOI：
10.18632/oncotarget.6452
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发表时间：
2015-12-15
期刊：
影响因子：
--
通讯作者：
Mei C
中科院分区：
文献类型：
--
作者：
Xue C;Zhou C;Dai B;Yu S;Xu C;Mao Z;Ye C;Chen D;Zhao X;Wu J;Chen W;Mei C
背景控制血压（BP）是常染色体显性多囊肾病（ADPKD）最重要的治疗方法之一。降压治疗对ADPKD患者的比较疗效尚无定论。方法采用网络荟萃分析方法对研究ADPKD患者降压治疗的随机对照试验（RCT）进行评价。检索PubMed、Embase、Ovid和Cochrane Collaboration。主要终点是估计肾小球滤过率（eGFR）。次要结果为血清肌酐（Scr）、尿白蛋白排泄（UAE）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和左心室质量指数（LVMI）。结果纳入10项随机对照试验，共1386例患者，6种干预措施：血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）、ACEI与ARB联合用药、钙通道阻滞剂（CCB）、β受体阻滞剂和地拉西普。在网络和直接比较中，所有处理的eGFR均无差异。在网络比较中，Scr、SBP、DBP、MAP和LVMI无显著差异。然而，与CCB相比，ACEI显著降低了收缩压、舒张压、MAP和LVMI。与ACEI或ARB相比，CCB患者的UAE明显增加。贝叶斯概率分析发现，ARB在eGFR、UAE和SBP的替代指标中排名第一。结论降压治疗对ADPKD患者肾脏疾病进展的影响无明显差异。未来还需要更多的随机对照试验。使用ARB可能是临床实践的最佳选择。
Background Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive. Methods Network meta-analysis was used to evaluate randomized controlled trials (RCT) which investigated antihypertensive treatments in ADPKD. PubMed, Embase, Ovid, and Cochrane Collaboration were searched. The primary outcome was estimated glomerular filtration rate (eGFR). Secondary outcomes were serum creatinine (Scr), urinary albumin excretion (UAE), systolic BP (SBP), diastolic BP (DBP), mean artery pressure (MAP) and left ventricular mass index (LVMI). Results We included 10 RCTs with 1386 patients and six interventions: angiotensin-converting enzyme inhibitors (ACEI), Angiotensin II receptor blocker (ARB), combination of ACEI and ARB, calcium channel blockers (CCB), β-blockers and dilazep. There was no difference of eGFR in all the treatments in both network and direct comparisons. No significant differences of Scr, SBP, DBP, MAP, and LVMI were found in network comparisons. However, ACEI significantly reduced SBP, DBP, MAP and LVMI when compared to CCB. Significantly increased UAE was observed in CCB compared with ACEI or ARB. Bayesian probability analysis found ARB ranked first in the surrogate measures of eGFR, UAE and SBP. Conclusions There is little evidence to detect differences of antihypertensive treatments on kidney disease progression in ADPKD patients. More RCTs will be needed in the future. Use of ARB may be an optimal choice in clinical practice.