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Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.

Khan UA, Garg AX, Parikh CR, Coca SG - PLoS ONE (2013)

Bottom Line: We searched Ovid, Medline and Embase for RCTs in which an intervention was given to prevent or slow the progression of CKD and mortality was reported as primary, secondary or adverse outcomes were eligible and selected.For the first phase, pooled relative risks for renal endpoints were assessed.Firm evidence is lacking that prevention of CKD translates into reductions in mortality.

View Article: PubMed Central - PubMed

Affiliation: Section of Nephrology, Yale University School of Medicine, Veterans Affairs Medical Center, and the Program of Applied Translational Research, New Haven, Connecticut, USA.

ABSTRACT

Objectives: To perform a systematic review of randomized controlled trials to determine whether prevention or slowing of progression of chronic kidney disease would translate into improved mortality, and if so, the attributable risk due to CKD itself on mortality.

Background: CKD is associated with increased mortality. This association is largely based on evidence from the observational studies and evidence from randomized controlled trials is lacking.

Methods: We searched Ovid, Medline and Embase for RCTs in which an intervention was given to prevent or slow the progression of CKD and mortality was reported as primary, secondary or adverse outcomes were eligible and selected. For the first phase, pooled relative risks for renal endpoints were assessed. For the second phase, we assessed the effect on mortality in trials of interventions that definitively reduced CKD endpoints.

Results: Among 52 studies selected in first phase, only renin-angiotensin-aldosterone-system blockade vs. placebo (n = 18 trials, 32,557 participants) met the efficacy criteria for further analysis in the second phase by reducing renal endpoints 15 to 27% compared to placebo. There was no difference in all-cause mortality (RR 0.99, 95% CI 0.92 to 1.08) or CV death (RR 0.97, 95% CI 0.78 to 1.21) between the treatment and control groups in these trials. There was sufficient statistical power to detect a 9% relative risk reduction in all-cause mortality and a 14% relative risk reduction in cardiovascular mortality.

Conclusions: Firm evidence is lacking that prevention of CKD translates into reductions in mortality. Larger trials with longer follow-up time are needed to determine the benefit of CKD prevention on survival.

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Related in: MedlinePlus

Flow Diagram of Study Selection Process.
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pone-0071784-g001: Flow Diagram of Study Selection Process.

Mentions: Our search identified 2844 citations for the first phase. Based on title and abstract review, we excluded 2631 citations. After a detailed review of 213 citations we further excluded 161 for various reasons. Among those, 20 trials had follow up time less than a year, 80 trials had small sample size, 19 trials did not report CKD outcomes or mortality, 30 citations were review articles or secondary analyses and 10 were excluded based on miscellaneous reasons (Figure 1). We also were unable to obtain full text in English and excluded those 2 trials. After a careful and thorough review, we included 52 trials in phase 1 [16]–[70]. The characteristics of these trials are listed in Table 1.


Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.

Khan UA, Garg AX, Parikh CR, Coca SG - PLoS ONE (2013)

Flow Diagram of Study Selection Process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756976&req=5

pone-0071784-g001: Flow Diagram of Study Selection Process.
Mentions: Our search identified 2844 citations for the first phase. Based on title and abstract review, we excluded 2631 citations. After a detailed review of 213 citations we further excluded 161 for various reasons. Among those, 20 trials had follow up time less than a year, 80 trials had small sample size, 19 trials did not report CKD outcomes or mortality, 30 citations were review articles or secondary analyses and 10 were excluded based on miscellaneous reasons (Figure 1). We also were unable to obtain full text in English and excluded those 2 trials. After a careful and thorough review, we included 52 trials in phase 1 [16]–[70]. The characteristics of these trials are listed in Table 1.

Bottom Line: We searched Ovid, Medline and Embase for RCTs in which an intervention was given to prevent or slow the progression of CKD and mortality was reported as primary, secondary or adverse outcomes were eligible and selected.For the first phase, pooled relative risks for renal endpoints were assessed.Firm evidence is lacking that prevention of CKD translates into reductions in mortality.

View Article: PubMed Central - PubMed

Affiliation: Section of Nephrology, Yale University School of Medicine, Veterans Affairs Medical Center, and the Program of Applied Translational Research, New Haven, Connecticut, USA.

ABSTRACT

Objectives: To perform a systematic review of randomized controlled trials to determine whether prevention or slowing of progression of chronic kidney disease would translate into improved mortality, and if so, the attributable risk due to CKD itself on mortality.

Background: CKD is associated with increased mortality. This association is largely based on evidence from the observational studies and evidence from randomized controlled trials is lacking.

Methods: We searched Ovid, Medline and Embase for RCTs in which an intervention was given to prevent or slow the progression of CKD and mortality was reported as primary, secondary or adverse outcomes were eligible and selected. For the first phase, pooled relative risks for renal endpoints were assessed. For the second phase, we assessed the effect on mortality in trials of interventions that definitively reduced CKD endpoints.

Results: Among 52 studies selected in first phase, only renin-angiotensin-aldosterone-system blockade vs. placebo (n = 18 trials, 32,557 participants) met the efficacy criteria for further analysis in the second phase by reducing renal endpoints 15 to 27% compared to placebo. There was no difference in all-cause mortality (RR 0.99, 95% CI 0.92 to 1.08) or CV death (RR 0.97, 95% CI 0.78 to 1.21) between the treatment and control groups in these trials. There was sufficient statistical power to detect a 9% relative risk reduction in all-cause mortality and a 14% relative risk reduction in cardiovascular mortality.

Conclusions: Firm evidence is lacking that prevention of CKD translates into reductions in mortality. Larger trials with longer follow-up time are needed to determine the benefit of CKD prevention on survival.

Show MeSH
Related in: MedlinePlus