The Effect of Fibrates on Kidney Function and Chronic Kidney Disease Progression: Protocol for a Systematic Review.

Abstract Background/Objectives: Fibrates reduce cardiovascular risk in the general population and in patients with chronic kidney disease (CKD). Although, they are commonly used as second-line agents in addition to statins for hypertriglyceridemia, their use in CKD is limited due to a decrease of glomerular filtration rate (GFR) at treatment initiation. This change in GFR is reversible with fibrate discontinuation. Importantly, randomised control trials with fibrate treatment have demonstrated reduction in proteinuria and benefit for microvascular diabetic complications. In addition, a number of experimental studies have shown nephroprotective effects with fibrates through attenuation of renal fibrosis and inflammation. Thus, the effect of fibrates on renal outcomes remains undetermined. The objective of this systematic review is to summarize the evidence from randomised controlled studies and provide pooled estimates on the effect of fibrates on short- and long-term renal outcomes. Methods/Design: The study will be contacted according to the Cochrane Collaboration principles for Systematic reviews. We will include randomised trials comparing fibrate to placebo or studies comparing the addition of fibrate on statin versus statin alone and reporting on the short- and long-term effects on renal function, CKD progression and proteinuria. We will examine studies including patients with established CKD and those studies including patients at risk of developing CKD, separately. A comprehensive summary of the evidence will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data from included studies suitable for metanalysis will be analyses accordingly to provide quantitative estimates using a random effects model. The Cochrane Collaboration tool for assessing the risk of bias in randomized clinical trials will be utilised. The quality of the evidence from included studies will be addressed descriptively using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).Discussion: The results of this systematic review will be informative for clinicians. A summary of high-level evidence with robust estimates of the effect of fibrates on safety and renal outcomes may be used to inform clinical practice guideline development for dyslipidaemias and primary and secondary prevention of CVD. Systematic review registration: PROSPERO CRD42020187764

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P1011ATHE SGTL-2 INHIBITORS DECREASE THE MORTALITY AND PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD) IN TYPE 2 DIABETES PATIENTES. SYSTEMATIC REVIEW AND META-ANALYSIS OF THE LITERATURE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1011a ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Sebastian Cabrera ◽

Ruben Torres ◽

Leticia Elgueta ◽

Erico Segovia ◽

Maria Eugenia Sanhueza ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Diabetic Nephropathy ◽

Kidney Disease ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Renal Outcome ◽

Diabetic Patients ◽

Renal Outcomes ◽

The Cochrane Collaboration ◽

Age Range

Abstract Background and Aims Diabetic nephropathy is one of the main causes of chronic kidney disease (CKD) in the world. In the past years new studies using SGLT-2 inhibitors in diabetic patients have shown benefit in both mortality and progression of CKD. However, these works show heterogeneity between studies regarding the severity of CKD of patients included. All above complicates the interpretation of the benefits of SGLT-2 inhibitors. Method We did a systematic search of the literature in PUBMED, EMBASE, Cochrane CENTRAL trials database and in references of the selected studies. Terms used for the search were Canaglifozin, Dapaglifozin, Ertuglifozin, Empaglifozin, diabetes, mortality and CKD. Search included studies in all languages. We selected only randomized and controlled studies that reported mortality and relevant renal outcomes (doubling serum creatinine or decrease in eGFR> 40%, need for renal replacement or renal death). We included studies until September 30, 2019. For the meta-analysis, a Mantel-Haenszel model of random effects was used. The software Review Manager, Version 5.3 The Cochrane Collaboration, 2014 was used. Results We obtained results from 142 studies, fifteen studies met the selected criteria, but only four reported mortality and renal outcomes (EMPA-REG, CANVAS, CREDENCE AND DECLARE-TIMI 58). A total of 38,721 patients (SGTL2 inhibitors n = 21,264 and control n = 17,457) were included for the analysis. The EMPA-REG study used Empaglifozin, the CANVAS and CREDENCE studies used Canaglifozin and the DECLARE-TIMI 58 used Dapaglifozin. All studies were funded by pharmaceutical laboratories.The average age range of the studies was between 62 to 67 years. The percentage of patients with eGFR <60ml/min were 26%, 20%, 60% and 7% for the EMPA-REG, CANVAS, CREDENCE and DECLARE-TIMI 58 studies respectively.Mortality was lower in patients who used SGTL2 inhibitors OR 0.86 (CI 0.80-0.94) Figure 1. Renal outcomes were also lower in patients who used SGTL-2 inhibitors OR 0.69 (CI 0.60-0.78) Figure 2. We assessed whether the effect was related to the severity of the CKD taking out the work with patients with more severe CKD (CREDENCE study), the effect on mortality did not change OR 0.87 (CI 0.80-0.95) as well as renal outcome OR 0.66 (CI 0.52- 0.83). Conclusion The SGTL-2 inhibitors decrease mortality and improve renal outcomes in patients with diabetic nephropathy. These benefits remain in patients with less severe CKD.

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Incidence of chronic kidney disease in patients undergoing arthroplasty: A systematic review of the literature

Orthopedic Reviews ◽

10.4081/or.2019.8157 ◽

2019 ◽

Vol 11 (4) ◽

Author(s):

Kateir Contreras ◽

Dayany Rodriguez ◽

Marcela Bernal-Gutiérrez ◽

Juan Pedro Villamizar ◽

Romar Baquero-Galvis ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Injury ◽

Cochrane Collaboration ◽

Review Of The Literature ◽

Factors Associated ◽

Acceptable Quality ◽

The Cochrane Collaboration

Patients undergoing arthroplasty are exposed to different interventions that can lead to renal dysfunction. There is abundant evidence of the incidence and factors associated with acute kidney injury (AKI); however, the incidence and the factors associated with chronic kidney disease (CKD) are not clear. The objective of this study is to determine the incidence and associated factors in arthroplasty patients. A systematic review of the literature was carried out following the recommendations of PRISMA and the Cochrane Collaboration (PROSPERO Protocol CRD42018075929). The search was carried out in Medline, Embase, Cochrane and LILACS. No language or date limits were set. Observational studies were included: cases and controls, and cohorts. The revision of titles and abstracts and the reading of the full texts was performed in a paired manner. The quality of the evidence was evaluated with the Newcastle-Ottawa tool. The initial search found 1279 titles and abstracts. We excluded 115 duplicates, and 1153 in the reading of titles and abstracts. Three articles met the inclusion criteria and were of acceptable quality. The incidence of severe CKD after hip or knee arthroplasty was 1.2% at 1 year up to 6.5% at 9 years. The evidence of the incidence and risk factors associated with CKD in patients undergoing arthroplasty is very scarce and heterogeneous. Further primary studies are required in order to have more valid and trustable results.

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