非透析依赖型 CKD 和缺血性心脏病患者接受冠状动脉血运重建的益处和危害：系统回顾与元分析

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology Pub Date : 2024-10-04 DOI:10.2215/cjn.0000000000000549

Dipal M. Patel, Lisa M. Wilson, Renee F. Wilson, Xuhao Yang, Troy Gharibani, Karen A. Robinson

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引用次数: 0

摘要

血管再通的好处。特别是在非透析依赖型慢性肾脏病患者中，有关这些风险和益处之间平衡的证据还很缺乏。方法：我们对随机对照试验（RCT）进行了系统性回顾，以评估与药物治疗相比，血管重建对患有缺血性心脏病和不需要肾脏替代治疗（透析或移植）的 CKD 成人或儿童的风险和益处。我们检索了 PubMed、Embase 和截至 2023 年 12 月 12 日的 Cochrane 对照试验中央注册中心 (CENTRAL)。两人独立筛选标题和摘要，然后进行全文审阅，使用标准化表格连续提取数据，独立评估偏倚风险，并对证据的确定性（COE）进行分级。研究结果通过评估九项研究的数据，我们发现与接受药物治疗的患者相比，接受血管重建治疗的慢性肾脏病和缺血性心脏病患者的全因死亡率较低（RR 0.80，95% CI 0.64-0.98；COE，低）。血管重建可降低心肌梗死（RR 0.81，95% CI 0.64-1.04；COE，低）和心力衰竭（RR 0.80，95% CI 0.52-1.23；COE，低）的发病率。对心血管死亡率的影响尚不确定（HR 0.67，95% CI 0.37-1.20；COE，极低）。患者报告的结果和肾脏不良事件的证据不足。由于患者群体的异质性和试验数量有限，数据受到限制。结论对于非透析依赖型 CKD 患者，与药物治疗相比，血管重建可降低全因死亡率，还可降低心血管事件的风险。需要更多有关肾脏和患者报告结果的数据，以全面参与共同决策，并确定针对慢性肾脏病和缺血性心脏病患者的最佳治疗策略。版权所有 © 2024 年美国肾脏病学会...

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Benefits and Harms of Coronary Revascularization in Non-Dialysis-Dependent CKD and Ischemic Heart Disease: A Systematic Review and Meta-Analysis

tweigh benefits of revascularization. Evidence on the balance of these risks and benefits, specifically in people with non-dialysis-dependent CKD, is lacking. Methods: We conducted a systematic review of randomized controlled trials (RCTs) to assess the risks and benefits of revascularization, compared to medical management, among adults or children with ischemic heart disease and CKD not requiring kidney replacement therapy (dialysis or transplantation). We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) through December 12th, 2023. Two people independently screened titles and abstracts followed by full-text review, serially extracted data using standardized forms, independently assessed risk of bias, and graded the certainty of evidence (COE). Results: Evaluating data from nine RCTs, we found that people with CKD and ischemic heart disease treated with revascularization may experience lower all-cause mortality compared to people receiving medical management (RR 0.80, 95% CI 0.64-0.98; COE, low). Revascularization may reduce incidence of myocardial infarction (RR 0.81, 95% CI 0.64-1.04; COE, low) and heart failure (RR 0.80, 95% CI 0.52-1.23; COE, low). The effect on cardiovascular mortality is uncertain (HR 0.67, 95% CI 0.37-1.20; COE, very low). Evidence was insufficient for patient-reported outcomes and adverse kidney events. Data were limited by heterogeneity of patient populations and the limited number of trials. Conclusions: In people with non-dialysis-dependent CKD, revascularization may be associated with lower all-cause mortality compared to medical management and may also lower the risk of cardiovascular events. Additional data surrounding kidney and patient-reported outcomes are needed to comprehensively engage in shared decision making and determine optimal treatment strategies for people with CKD and ischemic heart disease. Copyright © 2024 by the American Society of Nephrology...

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来源期刊

Clinical Journal of the American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

12.20

自引率

3.10%

发文量

514

审稿时长

3-6 weeks

期刊介绍： The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.