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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

Pooled Relative Risk for Mortality in RAAS Trials.
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pone-0071784-g003: Pooled Relative Risk for Mortality in RAAS Trials.

Mentions: Only eight RAAS trials reported on the outcome CV death (Figure 3a and Table 3). There were 627 deaths (6.8%) in treatment group vs. 656 deaths (7.1%) in control group (RR 0.97 [95% CI 0.78 to 1.21], RD 0 [95% CI −1 to 1], I2 = 67%). All 18 RAAS trials (20 total comparisons due to multiple arms in two trials) reported all-cause mortality (Figure 3b and Table 3). There were 1704 deaths (10.4%) in the RAAS treatment group vs. 1700 deaths (10.4%) in the control group (RR 0.99 [95% CI 0.92 to 1.08], RD 0 [95% CI 0 to 1], I2 = 29%). We had at least 80% power to detect a 14% relative risk reduction (RRR) in CV death and a 9% RRR in all-cause mortality at 2 sided alpha of 0.05 assuming baseline event rate in controls to be 7.1% and 10.4% respectively (Table 3).


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)

Pooled Relative Risk for Mortality in RAAS Trials.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0071784-g003: Pooled Relative Risk for Mortality in RAAS Trials.
Mentions: Only eight RAAS trials reported on the outcome CV death (Figure 3a and Table 3). There were 627 deaths (6.8%) in treatment group vs. 656 deaths (7.1%) in control group (RR 0.97 [95% CI 0.78 to 1.21], RD 0 [95% CI −1 to 1], I2 = 67%). All 18 RAAS trials (20 total comparisons due to multiple arms in two trials) reported all-cause mortality (Figure 3b and Table 3). There were 1704 deaths (10.4%) in the RAAS treatment group vs. 1700 deaths (10.4%) in the control group (RR 0.99 [95% CI 0.92 to 1.08], RD 0 [95% CI 0 to 1], I2 = 29%). We had at least 80% power to detect a 14% relative risk reduction (RRR) in CV death and a 9% RRR in all-cause mortality at 2 sided alpha of 0.05 assuming baseline event rate in controls to be 7.1% and 10.4% respectively (Table 3).

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