患有CKD的成人的维生素D疗法:系统性审查和元分析
Wing-Chi G Yeung1, Suetonia C Palmer2, Giovanni F M Strippoli3
1Department of Nephrology, Wollongong Hospital, Sydney, Australia; George Institute for Global Health, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.
概括
维生素D治疗可能不会减少慢性病 (CKD) 的全因死亡. 它对骨折,心血管和结局的影响仍然不确定,尽管它影响了某些CKD-MBD生物标志物.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 心血管医学 心血管医学
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 慢性病 (CKD) 增加死亡风险,心血管疾病和骨折,通常与CKD-矿物和骨疾病 (CKD-MBD) 相关.
- CKD-MBD涉及骨和矿物代谢的改变,导致血管化和骨质质差.
- 维生素D是一种常见的CKD-MBD治疗方法,需要对其临床影响进行评估.
研究的目的:
- 评估维生素D治疗对患有CKD的成年人死亡率,心血管,骨和结局的影响.
- 综合随机对照试验 (RCT) 关于维生素D在CKD管理中的有效性和安全性的证据.
主要方法:
- 系统性审查和对128个RCT的元分析,涉及11,270名患有3-5期CKD的参与者 (不包括移植接受者).
- 搜索了MEDLINE,Embase和CENTRAL数据库,截至2023年2月25日;包括具有≥3个月后续时间的RCT.
- 使用Cochrane RoB 2工具评估偏差风险,使用GRADE评估证据确定性;主要终点包括全因死亡,心血管死亡和骨折.
主要成果:
- 与安慰剂相比,维生素D治疗可能对所有原因死亡没有显著影响 (RR,1.04;95% CI,0.84-1.24).
- 对骨折 (RR,0.68;95% CI,0.37-1.23) 和心血管死亡 (RR,0.73;95% CI,0.31-1.71) 的影响是不确定的.
- 维生素D治疗降低了血清副甲状腺激素和性酸酶,但增加了血清水平.
结论:
- 维生素D治疗并没有降低患有CKD的个体因任何原因死亡的风险.
- 维生素D对CKD患者骨折,心血管和结局的影响仍然不确定.
- 限制包括短期的随访期,小样本大小,以及包含的研究中的试验质量不足.
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