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

<h4>Objectives</h4>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.<h4>Backgro...

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Autores principales:	Usman A Khan, Amit X Garg, Chirag R Parikh, Steven G Coca
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7aa75d81a8694b0294e9f9aaf59763b7
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spelling	oai:doaj.org-article:7aa75d81a8694b0294e9f9aaf59763b72021-11-18T08:57:47ZPrevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0071784https://doaj.org/article/7aa75d81a8694b0294e9f9aaf59763b72013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24009665/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>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.<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Usman A KhanAmit X GargChirag R ParikhSteven G CocaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 8, p e71784 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Usman A Khan Amit X Garg Chirag R Parikh Steven G Coca Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
description	<h4>Objectives</h4>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.<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Usman A Khan Amit X Garg Chirag R Parikh Steven G Coca
author_facet	Usman A Khan Amit X Garg Chirag R Parikh Steven G Coca
author_sort	Usman A Khan
title	Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
title_short	Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
title_full	Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
title_fullStr	Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
title_full_unstemmed	Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
title_sort	prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/7aa75d81a8694b0294e9f9aaf59763b7
work_keys_str_mv	AT usmanakhan preventionofchronickidneydiseaseandsubsequenteffectonmortalityasystematicreviewandmetaanalysis AT amitxgarg preventionofchronickidneydiseaseandsubsequenteffectonmortalityasystematicreviewandmetaanalysis AT chiragrparikh preventionofchronickidneydiseaseandsubsequenteffectonmortalityasystematicreviewandmetaanalysis AT stevengcoca preventionofchronickidneydiseaseandsubsequenteffectonmortalityasystematicreviewandmetaanalysis
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Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.

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