Objective: Toevaluate the effects of drug interventions that may modify the progression ofchronic kidney disease (CKD) in adults with CKD stages 3 and 4.
Design: Systematic review and meta-analysis.
Methods: SearchingMEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane CentralRegister of Controlled Trials, Cochrane Database of Systematic Reviews,International Clinical Trials Registry Platform, Health Technology Assessment,Science Citation Index, Social Sciences Citation Index, Conference ProceedingsCitation Index and Clinical Trials Register, from March 1999 to July 2018, weidentified randomised controlled trials (RCTs) of drugs for hypertension, lipidmodification, glycaemic control and sodium bicarbonate, compared with placebo,no drug or a drug from another class, in ≥40 adults with CKD stages 3 and/or 4,with at least 2 years of follow-up and reporting renal function (primaryoutcome), proteinuria, adverse events, maintenance dialysis, transplantation,cardiovascular events, cardiovascular mortality or all-cause mortality. Tworeviewers independently screened citations and extracted data. For continuousoutcomes, we used the ratio of means (ROM) at the end of the trial inrandom-effects meta-analyses. We assessed methodological quality with theCochrane Risk of Bias Tool and confidence in the evidence using the Grading ofRecommendations Assessment, Development and Evaluation (GRADE) framework.
Results: Weincluded 35 RCTs and over 51 000 patients. Data were limited, and heterogeneityvaried. Final renal function (estimated glomerular filtration rate) was 6%higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10,I2=0%, low GRADE confidence) and 4% higher in those taking lipid-modifyingdrugs (ROM 1.04, 95% CI 1.00 to 1.08, I2=88%, very low GRADE confidence). ForRCTs of antihypertensive drugs, there were no significant differences in renalfunction. Treatment with lipid-modifying drugs led to a 36% reduction incardiovascular disease and 26% reduction in all-cause mortality.
Conclusions: Glycaemiccontrol and lipid-modifying drugs may slow the progression of CKD, but we foundno pooled evidence of benefit nor harm from antihypertensive drugs. However,given the data limitations, further research is needed to confirm thesefindings.
PROSPERO registrationnumber: CRD42015017501.
- Cardiovascular events
- Chronic renal failure
- Drug treatment
- Renal function
ASJC Scopus subject areas