scholarly journals Effectiveness of Drug Treatments for Lowering Uric Acid on Renal Function in Patients With Chronic Kidney Disease and Hyperuricemia: A Network Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiang Liu ◽  
Yuxuan Qiu ◽  
Duohui Li ◽  
Jiaxing Tan ◽  
Xiuping Liang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register

Background: Hyperuricemia is very common in patients with chronic kidney disease (CKD); the role of hyperuricemia in the occurrence and progression of kidney disease remains an interesting and unresolved issue for nephrologists, and whether urate-lowering therapy (ULT) is warranted in CKD patients is still in controversy. To summarize and compare the clinical outcomes and adverse events (AEs) of three common ULT drugs, we performed a systematic review and network meta-analysis of randomized clinical trials (RCTs).Method: PubMed, MEDLINE, Clinical Trials.gov, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched. The network meta-analysis was performed using the “gemtc 0.8-7” and its dependent packages in R software. The primary outcome was the change of renal function and uric acid; creatinine, proteinuria, blood pressure, and adverse events were assessed as the secondary outcomes.Results: 16 RCTs involving 1,943 patients were included in the final network analysis. Febuxostat, allopurinol, and benzbromarone were not found to exert superior effects over placebo upon renoprotective effect. With respect to lowering urate, the three drugs showed to be statistically superior to placebo, while febuxostat could better lower urate than allopurinol (MD: −1.547; 95% CrI: −2.473 to −0.626). It is also indicated that febuxostat was superior to placebo at controlling blood pressure, while no differences were observed when allopurinol and benzbromarone were compared to placebo. These results are stable in subgroup analysis.Conclusion: There is insufficient evidence to support the renoprotective effects of the three urate-lowering agents in CKD patients with hyperuricemia; febuxostat shows a tendency to be superior to allopurinol on lowering the decline of eGFR and increment of proteinturia, but the difference does not reach a statistical significance. Regarding its urate-lowering effect, febuxostat appears to be a satisfactory alternative to allopurinol and benzbromarone, and can control blood pressure better.

Effects of combined aerobic and resistance exercise on renal function in adult patients with chronic kidney disease: a systematic review and meta-analysis

2020 ◽  
Vol 34 (7) ◽  
pp. 851-865 ◽  
Author(s):  
Xiaoxia Wu ◽  
Lei Yang ◽  
Ying Wang ◽  
Chunfeng Wang ◽  
Rong Hu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Resistance Exercise ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Group Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

Objectives: Combined aerobic and resistance exercise (CARE) is beneficial for improving renal function. To confirm this, we conducted a meta-analysis to evaluate the effects of CARE on renal function in adult patients with chronic kidney disease (CKD). Date sources: The last date of search was 22 February 2020. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Allied and Complementary Medicine (AMED), CINAHL, Web of Science, SPORTDiscus, and three Chinese databases (China National Knowledge Infrastructure (CNKI), Wangfang, Journal Integration Platform (VIP)) for articles of randomized and quasi-randomized controlled trials. Methods: We used the Cochrane tool and the JBI Critical Appraisal checklist to assess randomized controlled trials and quasi-randomized controlled trials, respectively. Result: A total of 12 studies and 745 patients were included. Compared with usual care or no exercise, CARE resulted in a significant improvement in the estimated glomerular filtration rate (between-group analysis: mean difference (MD) =5.01, 95% confidence interval (CI): 2.37 to 7.65; within-group analysis: MD = 3.01, 95% CI: 0.86 to 5.16). The serum creatinine levels also showed a significant improvement after CARE (between-group analysis: MD = −8.57, 95% CI: −13.71 to −3.43; within-group analysis: MD = −6.33, 95% CI: −10.23 to −2.44). Patients who performed CARE also demonstrated a decline in the blood pressure in the within-group analysis (systolic blood pressure: MD = −5.24, 95% CI: −7.93 to −2.54; diastolic blood pressure: MD = −3.63, 95% CI: −5.35 to −1.91). However, there were no significant differences in proteinuria, lipid levels, physical composition, and quality of life. Conclusion: The study results support the concept that CARE intervention improves renal function. It provides strong evidence for guiding clinical decisions and implementing renal rehabilitation exercises.

scholarly journals SO012RENOPROTECTIVE EFFECTS OF FEBUXOSTAT AND ALLOPURINOL IN PATIENTS WITH HYPERURICEMIA AND CHRONIC KIDNEY DISEASES: A META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sherida Edding ◽  
Brian Michael Cabral ◽  
Monica Therese Cating-Cabral
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Mean Difference ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background and Aims Hyperuricemia is associated with rapid deterioration of renal function in patients with chronic kidney disease (CKD). The two most common urate-lowering drugs available in the market are allopurinol and febuxostat. Randomized controlled trials (RTCs) have shown that the individual drugs have potential to slow down progression of renal function in patients with chronic kidney disease (CKD) and hyperuricemia. However, it is unclear which drug is more effective because of insufficient direct comparison between the two. Hence our study aims to perform a meta-analysis of RCTs to assess the renoprotective and urate-lowering effects between the two drugs in patients with CKD and hyperuricemia. Method A comprehensive literature search of randomized controlled trials using PubMed was performed with the following search terms: febuxostat, allopurinol, chronic kidney disease, renoprotection. Four prospective RCTs were selected and analyzed using Cochrane Revman v5.3. Outcomes assessed were change in serum creatinine, estimated glomerular filtration rate (eGFR), proteinuria and serum uric acid levels from baseline to 3 months post-initiation of therapy. Results Four relevant trials comprising of 486 patients were selected - 247 patients treated with febuxostat and 239 patients with allopurinol. No significant differences were found in the changes in serum creatinine (mean difference -0.04; CI -0.15, 0.07; P = 0.51) and eGFR (mean difference 1.57; CI -0.83, 3.97; P = 0.20) from baseline to 3 months between the febuxostat and allopurinol group. Decrease in proteinuria was significantly observed more in the febuxostat group (mean difference -50.13; CI -90.54; -9.71, P = 0.02). Similarly, serum uric acid levels were significantly more reduced in the febuxostat group (mean difference -1.11; CI -1.53, -0.68, P < 0.00001). Conclusion Our study showed that febuxostat is non-inferior in terms of delaying renal function decline (as measured by eGFR) but it offers a better anti-proteinuric as well as a urate-lowering effect. However, more studies are needed to assess the efficacy of febuxostat across the spectrum of chronic kidney disease, including those requiring hemodialysis.

scholarly journals Correction: The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0233869
Author(s):  
Stephanie Thompson ◽  
Natasha Wiebe ◽  
Raj S. Padwal ◽  
Gabor Gyenes ◽  
Samuel A. E. Headley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Outcomes of coronavirus 2019 infection in patients with chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199886
Author(s):  
Yi-Chih Lin ◽  
Tai-Shuan Lai ◽  
Shuei-Liong Lin ◽  
Yung-Ming Chen ◽  
Tzong-Shinn Chu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Case Series ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
All Cause Mortality

Background: Information on coronavirus disease 2019 (COVID-19) infection in patients with chronic kidney disease (CKD) remains limited. To understand the influence of COVID-19 infection in patients with pre-existing CKD, we conducted a systematic review and meta-analysis to evaluate and compare the risks of all-cause mortality, hospitalization, and critical progression between patients with and without CKD. Methods: We selected randomized controlled trials (RCTs), prospective or retrospective observational, case-control, cross-sectional, and case-series studies analyzing outcomes of COVID-19 infection in patients with pre-existing CKD from the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases published on the Internet before 16 July 2020. Results: A total of 27 studies comprising 77,856 patients with COVID-19 infection was identified; 3922 patients with pre-existing CKD were assigned CKD group, and 73,934 patients were assigned to the non-CKD group. The pooled analysis showed that patients with CKD had a significantly higher risk of all-cause mortality and hospitalization than those without CKD [odds ratio (OR) 2.25, 95% confidence interval (CI) 1.91–2.66, p < 0.001; OR 4.29, 95% CI 2.93–6.28, p < 0.001; respectively]. Patients with CKD had a higher risk of critically ill conditions than those without CKD in the pooled analysis of studies with multivariable adjustment (adjusted OR 2.12, 95% CI 0.95–4.77, p = 0.07) and in the analysis of all included studies (OR 1.27, 95% CI 0.71–2.26, p = 0.41), but both analyses did not attain statistical significance. Conclusion: COVID-19 infected patients with CKD had significantly increased risks of all-cause mortality and hospitalization compared with those without CKD.

scholarly journals Effect of a High-Protein Diet on the Renal Function in Healthy Individuals Without Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Zhijuan Xie ◽  
Jihong Ou ◽  
Yan Zhu
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Meta Analysis ◽  
High Protein Diet ◽  
Serum Urea ◽  
Obese Adults ◽  
Low Protein ◽  
Obese Subjects

Abstract BackgroundHigh-protein (HP) diets have been recommended for weight loss including obese persons. However, the potential effects of HP regimens on kidney health for persons without chronic kidney disease (CKD) are still controversial. MethodsTo investigate the effects of HP diets versus standard protein/low protein (SP/LP) ones on renal function in individuals without CKD, we conducted this meta-analysis. ResultsThirty-nine RCTs including 3400 participants were considered in this meta-analysis. HP diets resulted in an increased GFR (standardized mean difference [SMD] = 0.64, 95% confidence interval [CI]: 0.03, 1.26) and concentrations of serum urea (MD = 1.05, 95% CI: 0.66, 1.44), creatinine (MD = 2.94, 95% CI: 1.30, 4.58), and uric acid (MD = 19.89, 95% CI: 12.35, 27.43) in obese subjects when compared with SP/LP diets. The results in T2D and health participants did not show a notable detrimental effect on renal outcomes. Subgroup analysis showed that an increase in GFR was presented in obese subjects following an intervention shorter than 6 months. No significant differences were found in the urinary albumin excretion between the HP and SP/LP diets in obese and T2D populations, except for the healthy participants which was reported by only one study.ConclusionsThis meta-analysis showed that HP diets were associated with increased GFR, serum urea, creatinine, and uric acid in obese adults. Future studies are warranted to examine whether resulted glomerular hyperfiltration from HP diet can cause kidney damage in obese individuals.

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