■在晚期慢性肾脏病(CKD)患者中,开始使用血管紧张素转换酶抑制剂(ACEi)或血管紧张素受体阻滞剂(ARB)治疗对替代治疗(KFRT)肾衰竭和死亡风险的影响尚不清楚.
■为了检查ACEi或ARB治疗开始的关联,相对于非ACEi或ARB比较器,KFRT和死亡率。
■OvidMedline和慢性肾脏疾病流行病学合作临床试验联合会,从1946年到2023年12月31日。
■完成了随机对照试验,测试了ACEi或ARB与比较物(安慰剂或ACEi或ARB以外的抗高血压药物)的关系,其中包括基线估计肾小球滤过率(eGFR)低于30mL/min/1.73m2的患者。
■主要结果是KFRT,次要结局是KFRT前死亡。根据意向治疗原则使用Cox比例风险模型进行分析。根据基线年龄(<65vs.≥65岁),eGFR(<20vs.≥20mL/min/1.73m2),白蛋白尿(尿白蛋白-肌酐比值<300vs.≥300mg/g),和糖尿病病史。
■共纳入18项试验的1739名参与者,平均年龄为54.9岁,平均eGFR为22.2mL/min/1.73m2,其中624(35.9%)发生KFRT,133(7.6%)在34个月的中位随访期间死亡(IQR,19至40个月)。总的来说,ACEi或ARB治疗开始导致KFRT风险降低(调整后的风险比,0.66[95%CI,0.55至0.79]),但不是死亡(危险比,0.86[CI,0.58至1.28])。ACEi或ARB治疗与年龄之间无统计学意义的交互作用,eGFR,白蛋白尿,或糖尿病(所有交互作用P>0.05)。
■无法获得高钾血症或急性肾损伤的个体参与者水平数据。
■启动ACEi或ARB治疗可预防KFRT,但不是死亡,患有晚期CKD的人。
■美国国立卫生研究院。(PROSPERO:CRD42022307589)。
UNASSIGNED: In patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear.
UNASSIGNED: To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death.
UNASSIGNED: Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023.
UNASSIGNED: Completed randomized controlled trials testing either an ACEi or an ARB versus a comparator (placebo or antihypertensive drugs other than ACEi or ARB) that included patients with a baseline estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2.
UNASSIGNED: The primary outcome was KFRT, and the secondary outcome was death before KFRT. Analyses were done using Cox proportional hazards models according to the intention-to-treat principle. Prespecified subgroup analyses were done according to baseline age (<65 vs. ≥65 years), eGFR (<20 vs. ≥20 mL/min/1.73 m2), albuminuria (urine albumin-creatinine ratio <300 vs. ≥300 mg/g), and history of diabetes.
UNASSIGNED: A total of 1739 participants from 18 trials were included, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m2, of whom 624 (35.9%) developed KFRT and 133 (7.6%) died during a median follow-up of 34 months (IQR, 19 to 40 months). Overall, ACEi or ARB treatment initiation led to lower risk for KFRT (adjusted hazard ratio, 0.66 [95% CI, 0.55 to 0.79]) but not death (hazard ratio, 0.86 [CI, 0.58 to 1.28]). There was no statistically significant interaction between ACEi or ARB treatment and age, eGFR, albuminuria, or diabetes (P for interaction > 0.05 for all).
UNASSIGNED: Individual participant-level data for hyperkalemia or acute kidney injury were not available.
UNASSIGNED: Initiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD.
UNASSIGNED: National Institutes of Health. (PROSPERO: CRD42022307589).