Metformin Use and Risk of All-Cause Mortality and Cardiovascular Events in Patients With Chronic Kidney Disease-A Systematic Review and Meta-Analysis.
Metformin Use and Risk of All-Cause Mortality and Cardiovascular Events in Patients With Chronic Kidney Disease-A Systematic Review and Meta-Analysis.
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DOI：
10.3389/fendo.2020.559446
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发表时间：
2020
影响因子：
5.2
通讯作者：
Fu P
中科院分区：
文献类型：
--
作者：
Hu Y;Lei M;Ke G;Huang X;Peng X;Zhong L;Fu P
评估二甲双胍的使用是否确实改变了2型糖尿病(T2 DM)和慢性肾脏疾病(CKD)患者的全死因死亡率。系统地检索了PubMed、Web of Science、Embase和Cochrane Central Register of Control Trials，从最初到2020年2月29日，没有语言限制。所有比较使用二甲双胍(单一治疗或联合治疗)和非二甲双胍治疗的T2 DM和CKD患者的全原因死亡的相关文章都被确定。使用随机效应模型计算合并风险比(RR)和95%可信区间(CI)，而不考虑Cochraneχ2和I2统计量所量化的异质性。共纳入13篇研究(9篇队列研究，3篇随机对照试验的亚分析或后分析，1篇嵌套病例对照文章)，涉及303,540名患者。在G1-3期的CKD患者中，与任何其他指标相比，基于二甲双胍的治疗显示出显著较低的全因死亡率(合并RRS为0.71，95%CI为0.61至0.84；I2=79.0%)和心血管事件(合并RR为0.76，95%CI为0.60至0.97；I2=87.0%)，且具有显著的异质性。在晚期CKD患者中，二甲双胍的使用与这些终点没有明显的相关性。在T2 DM和轻/中度CKD患者中，二甲双胍的使用与全因死亡率和心血管事件的风险显著降低有关。然而，未来有必要进行大样本量的随机对照试验，以评估这些关键益处是否通过剂量调整延伸到CKD的后期阶段。
To evaluate whether metformin use assuredly alters overall all-cause death in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Pubmed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from inception to Feb. 29, 2020 with no language restriction. All related articles comparing all-cause death of T2DM and CKD patients after metformin use (monotherapy or combination) versus non-metformin treatment were identified. Pooled risk ratios (RR) and 95% confidence intervals (CI) were computed using random-effects models regardless of the heterogeneity quantified by Cochrane χ2 and I2 statistics. Totally 13 studies (9 cohort studies [CSs], 3 subanalyses or post-hoc analyses of randomized controlled trials [RCTs], and 1 nested case-control article) involving 303,540 patients were included. Metformin-based treatments relative to any other measure displayed significantly lower risks of all-cause mortality (Pooled RRs 0.71, 95%CI 0.61 to 0.84; I2 = 79.0%) and cardiovascular events (Pooled RRs 0.76, 95%CI 0.60 to 0.97; I2 = 87.0%) in CKD patients at stage G1-3, with substantial heterogeneity. Metformin use was not significantly related with these end points in advanced CKD patients. Metformin use is connected with significantly less risks of all-cause mortality and cardiovascular events in patients with T2DM and mild/moderate CKD. However, RCTs with large sample sizes are warranted in the future to assess whether these key benefits extend to later stages of CKD by dose adjustment.