背景:到目前为止,没有明确的干预措施来减轻血液透析患者的血管钙化(VC).本网络荟萃分析旨在系统评价硫代硫酸钠的临床疗效,双膦酸盐,和西那卡塞治疗血管钙化。
方法:使用PubMed进行了全面的研究搜索,WebofScience,Cochrane图书馆,EMBASE和中国国民知识互联网(CNKI)收集硫代硫酸钠的随机对照试验(RCT),双膦酸盐,和西那卡塞用于血液透析患者的血管钙化。然后,采用Stata17.0软件进行网络荟萃分析。
结果:总计,包括1083例患者在内的11项RCTs符合这项荟萃分析的资格。我们发现西那卡塞(SMD-0.59;95%CI[-0.95,-0.24])与常规治疗相比对血管钙化有显著的益处。而硫代硫酸钠或双膦酸盐没有显示出这样的效率。此外,至于疗效评估的排名,西那卡塞在减少血管钙化的累积排序曲线(SUCRA)下具有最高的表面(88.5%),优于硫代硫酸钠(50.4%)和双膦酸盐(55.4%)。因此,以上结果提示西那卡塞可能是治疗血液透析患者血管钙化最有前景的药物。机械上,我们的研究结果表明西那卡塞降低了血清钙(SMD-1.20;95%CI[-2.08,-0.33]),并显示出维持完整甲状旁腺激素(iPTH)水平平衡的趋势.
结论:该网络荟萃分析表明,西那卡塞似乎比硫代硫酸钠和双膦酸盐更有效地通过降低血清钙和iPTH来减轻血管钙化。西那卡塞可能是临床实践中VC血液透析患者的合理选择。
背景:[http://www.crd.约克。AC.uk/PROSPERO],标识符[CRD42022379965]。
BACKGROUND: Up to now, there is no unequivocal intervention to mitigate vascular calcification (VC) in patients with hemodialysis. This network meta-analysis aimed to systematically evaluate the clinical efficacy of sodium thiosulfate,
bisphosphonates, and cinacalcet in treating vascular calcification.
METHODS: A comprehensive study search was performed using PubMed, Web of Science, the Cochrane Library, EMBASE and
China National Knowledge Internet (CNKI) to collect randomized controlled trials (RCTs) of sodium thiosulfate,
bisphosphonates, and cinacalcet for vascular calcification among hemodialysis patients. Then, network meta-analysis was conducted using Stata 17.0 software.
RESULTS: In total, eleven RCTs including 1083 patients were qualified for this meta-analysis. We found that cinacalcet (SMD - 0.59; 95% CI [-0.95, -0.24]) had significant benefit on vascular calcification compared with conventional therapy, while sodium thiosulfate or bisphosphonates did not show such efficiency. Furthermore, as for ranking the efficacy assessment, cinacalcet possessed the highest surface under the cumulative ranking curve (SUCRA) value (88.5%) of lessening vascular calcification and was superior to sodium thiosulfate (50.4%) and
bisphosphonates (55.4%). Thus, above results suggested that cinacalcet might be the most promising drug for vascular calcification treatment in hemodialysis patients. Mechanistically, our findings illustrated that cinacalcet reduced serum calcium (SMD - 1.20; 95% CI [-2.08, - 0.33]) and showed the tendency in maintaining the balance of intact Parathyroid Hormone (iPTH) level.
CONCLUSIONS: This network meta-analysis indicated that cinacalcet appear to be more effective than sodium thiosulfate and
bisphosphonates in mitigating vascular calcification through decreasing serum calcium and iPTH. And cinacalcet might be a reasonable option for hemodialysis patients with VC in clinical practice.
BACKGROUND: [ http://www.crd.york.ac.uk/PROSPERO ], identifier [CRD42022379965].