The Dose-Dependent Effect of Nesiritide on Renal Function in Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Acute decompensated heart failure (ADHF) is a life-threatening and costly disease. Controversy remainsregarding the efficacy and renal tolerability of ultrafiltration for treating ADHF. We therefore performed thismeta-analysis to evaluate this clinical issue.Methods: A search of PubMed, EMBASE, and the Cochrane database of controlled trials was performed from inceptionto March 2021 for relevant randomized controlled trials. The quality of the included trials and outcomes wasevaluated with the use of the risk of bias assessment tool and the Grading of Recommendations, Assessment, Developmentand Evaluation (GRADE) approach, respectively. The risk ratio and the standardized mean difference (SMD) or weighted mean difference (WMD) were computed and pooled with fixed-effects or random-effects models.Results: This meta-analysis included 19 studies involving 1281 patients. Ultrafiltration was superior to the controltreatments for weight loss (WMD 1.24 kg, 95% confidence interval [CI] 0.38–2.09 kg, P = 0.004) and fluid removal(WMD 1.55 L, 95% CI 0.51–2.59 l, P = 0.003) and was associated with a significant increase in serum creatinine levelcompared with the control treatments (SMD 0.15 mg/dL, 95% CI 0.00–0.30 mg/dL, P = 0.04). However, no significanteffects were found for serum N-terminal prohormone of brain natriuretic peptide level, length of hospital stay, all-causemortality, or all-cause rehospitalization in the ultrafiltration group.Conclusions: The use of ultrafiltration in patients with ADHF is superior to the use of the control treatments for weight loss and fluid removal, but has adverse renal effects and lacks significant effects on long-term prognosis, indicatingthat this approach to decongestion in ADHF patients is efficient for fluid management but less safe renally.

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Dose-dependent effect of nuts on blood pressure: a systematic review and meta-analysis of randomized controlled trials

10.1101/2021.05.21.21257564 ◽

2021 ◽

Author(s):

Ahmad Jayedi ◽

Tauseef Ahmad Khan ◽

Amin Mirrafiei ◽

Bahareh Jabbarzadeh ◽

Yasaman Hosseini ◽

...

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Dependent Effect ◽

Randomized Controlled ◽

Long Term Follow Up ◽

Meta Analyses ◽

Dose Dependent ◽

Dose Dependent Effect

Objective: Traditional pairwise meta-analyses indicated that nuts consumption can improve blood pressure. We iamed to determine the dose-dependent effect of nuts on systolic (SBP) and diastolic blood pressure (DBP) in adults. Methods: A systematic search was undertaken in PubMed, Scopus, and ISI Web of Science till March 2021. Randomized controlled trials (RCT) evaluating the effects of nuts on SBP and DBP in adults were included. We estimated change in blood pressure for each 20 g/d increment in nut consumption in each trial and then, calculated mean difference (MD) and 95%CI using a random-effects model. We estimated dose-dependent effect using a dose-response meta-analysis of differences in means. The certainty of evidence was rated using the GRADE instrument, with the minimal clinically important difference being considered 2 mmHg. Results: A total of 31 RCTs with 2784 participants were included. Each 20 g/d increase in nut consumption reduced SBP (MD: -0.50 mmHg, 95%CI: -0.79, -0.21; I2 = 12%, n = 31; GRADE = moderate certainty) and DBP (MD: -0.23 mmHg, 95%CI: -0.38, -0.08; I2 = 0%, n = 31; GRADE = moderate certainty). The effect of nuts on SBP was more evident in patients with type 2 diabetes (MD: -1.31, 95%CI: -2.55, -0.05; I2 = 31%, n = 6). The results were robust in the subgroup of trials with low risk of bias. Levels of SBP decreased proportionally with the increase in nuts consumption up to 40 g/d (MD40g/d: -1.60, 95%CI: -2.63, -0.58), and then appeared to plateau with a slight upward curve. A linear dose-dependent reduction was seen for DBP, with the greatest reduction at 80 g/d (MD80g/d: -0.80, 95%CI: -1.55, -0.04). Conclusions: The available evidence provides a good indication that nut consumption can result in a small improvement in blood pressure in adults. Well-designed trials are needed to confirm the findings in long term follow-up.

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