晚期慢性病的 ангиотензин转化酶抑制剂或 ангиотензин受体阻断剂:临床试验的系统性审查和回顾性个人参与者级别的元分析
Elaine Ku1, Lesley A Inker2, Hocine Tighiouart3
1Departments of Medicine and Pediatrics, Division of Nephrology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (E.K.).
Annals of internal medicine
|July 1, 2024
概括
启动血管素转化酶抑制剂 (ACEi) 或血管素受体抑制剂 (ARB) 显著降低晚期慢性病 (CKD) 中功能衰竭的风险. 然而,这些疗法似乎没有降低这种患者群体的死亡风险.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学 是一个学科.
- 临床试验 临床试验
背景情况:
- 启动动血管素转化酶抑制剂 (ACEi) 或血管素受体抑制剂 (ARB) 对用替代疗法 (KFRT) 治疗功能衰竭和晚期慢性病 (CKD) 死亡率的影响尚未明确.
- 晚期CKD患者经常面临KFRT和死亡的高风险,需要明确的治疗指南.
研究的目的:
- 研究开始ACEi或ARB治疗与非ACEi/ARB比较剂之间的关联,以及晚期CKD患者的KFRT和死亡率.
- 为使用ACEi和ARB在管理高级CKD方面提供基于证据的指导.
主要方法:
- 对已完成的随机对照试验 (RCT) 进行了系统审查和元分析,使用来自Ovid Medline和CKD流行病学协作临床试验联盟的数据,直到2023年12月31日.
- 包括的RCT涉及患者估计的淋巴细胞过率 (eGFR) 低于30mL/min/1.73m2,将ACEi或ARB与安慰剂或其他抗高血压药物进行比较.
- 主要结局是KFRT;次要结局是死亡. 分析使用了Cox比例危险模型,根据年龄,eGFR,白色素尿和糖尿病史进行了分组分析.
主要成果:
- 该分析包括来自18项试验的1739名参与者,平均eGFR为22.2mL/min/1.73m2和34个月的中位随访.
- 开始ACEi或ARB治疗与显著降低KFRT风险相关 (调整后危险比率,0.66;95% CI,0.55至0.79).
- 没有观察到死亡风险显著降低 (危险比,0.86;95% CI,0.58至1.28),并且没有发现跨子组的显著相互作用.
结论:
- 开始ACEi或ARB治疗表明,在患有晚期慢性病的患者中,替代疗法对功能衰竭具有保护作用.
- 这些药物似乎没有降低这种患者群体的死亡风险.
- 进一步的研究可能会探索特定的子组或替代结果措施,尽管目前的数据表明,KFRT预防有明显的益处.
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