Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis
Background and Aims: The benefits and safety of antidyslipidemia pharmacotherapy in patients with chronic kidney disease were not well defined so the latest evidence was summarized by this work. Methods: This systematic review and Bayesian network meta-analysis (NMA) included searches of PubMed, Emb...
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| Format: | Article |
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MDPI AG
2022-12-01
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| Series: | Pharmaceutics |
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| Online Access: | https://www.mdpi.com/1999-4923/15/1/6 |
| _version_ | 1797437839596584960 |
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| author | Guangzhi Liao Xiangpeng Wang Yiming Li Xuefeng Chen Ke Huang Lin Bai Yuyang Ye Yong Peng |
| author_facet | Guangzhi Liao Xiangpeng Wang Yiming Li Xuefeng Chen Ke Huang Lin Bai Yuyang Ye Yong Peng |
| author_sort | Guangzhi Liao |
| collection | DOAJ |
| description | Background and Aims: The benefits and safety of antidyslipidemia pharmacotherapy in patients with chronic kidney disease were not well defined so the latest evidence was summarized by this work. Methods: This systematic review and Bayesian network meta-analysis (NMA) included searches of PubMed, Embase, and Cochrane Library from inception to 28 February 2022, for randomized controlled trials of any antilipidaemic medications administered to adults with chronic kidney disease [CKD: defined as estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m<sup>2</sup> not undergoing transplantation], using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the certainty of the evidence. Results: 55 trials and 30 works of them were included in our systematic review and NMA, respectively. In comparisons with no antidyslipidemia therapy or placebo, proprotein convertase subtilisin/Kexin type 9 inhibitors plus statin (PS) was the most effective drug regimen for reducing all-cause mortality (OR 0.62, 95% CI [0.40, 0.93]; GRADE: moderate), followed by moderate-high intensity statin (HS, OR 0.76, 95% CI [0.60, 0.93]; I<sup>2</sup> = 66.9%; GRADE: moderate). PS, HS, low-moderate statin (LS), ezetimibe plus statin (ES), and fibrates (F) significantly decreased the composite cardiovascular events. The subgroup analysis revealed the null effect of statins on death (OR 0.92, 95% CI [0.81, 1.04]) and composite cardiovascular events (OR 0.94, 95% CI [0.82, 1.07]) in dialysis patients. Conclusion: In nondialysis CKD patients, statin-based therapies could significantly and safely reduce all-cause death and major composite cardiovascular events despite the presence of arteriosclerotic cardiovascular disease and LDL-c levels. Aggressive medication regimens, PS and HS, appeared to be more effective, especially in patients with established CAD. |
| first_indexed | 2024-03-09T11:28:27Z |
| format | Article |
| id | doaj.art-5dfe8951998c4c2da9d4f4b1c96fc353 |
| institution | Directory Open Access Journal |
| issn | 1999-4923 |
| language | English |
| last_indexed | 2024-03-09T11:28:27Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceutics |
| spelling | doaj.art-5dfe8951998c4c2da9d4f4b1c96fc3532023-11-30T23:56:20ZengMDPI AGPharmaceutics1999-49232022-12-01151610.3390/pharmaceutics15010006Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-AnalysisGuangzhi Liao0Xiangpeng Wang1Yiming Li2Xuefeng Chen3Ke Huang4Lin Bai5Yuyang Ye6Yong Peng7Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaWest China School of Medicine, Sichuan University, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, ChinaBackground and Aims: The benefits and safety of antidyslipidemia pharmacotherapy in patients with chronic kidney disease were not well defined so the latest evidence was summarized by this work. Methods: This systematic review and Bayesian network meta-analysis (NMA) included searches of PubMed, Embase, and Cochrane Library from inception to 28 February 2022, for randomized controlled trials of any antilipidaemic medications administered to adults with chronic kidney disease [CKD: defined as estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m<sup>2</sup> not undergoing transplantation], using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the certainty of the evidence. Results: 55 trials and 30 works of them were included in our systematic review and NMA, respectively. In comparisons with no antidyslipidemia therapy or placebo, proprotein convertase subtilisin/Kexin type 9 inhibitors plus statin (PS) was the most effective drug regimen for reducing all-cause mortality (OR 0.62, 95% CI [0.40, 0.93]; GRADE: moderate), followed by moderate-high intensity statin (HS, OR 0.76, 95% CI [0.60, 0.93]; I<sup>2</sup> = 66.9%; GRADE: moderate). PS, HS, low-moderate statin (LS), ezetimibe plus statin (ES), and fibrates (F) significantly decreased the composite cardiovascular events. The subgroup analysis revealed the null effect of statins on death (OR 0.92, 95% CI [0.81, 1.04]) and composite cardiovascular events (OR 0.94, 95% CI [0.82, 1.07]) in dialysis patients. Conclusion: In nondialysis CKD patients, statin-based therapies could significantly and safely reduce all-cause death and major composite cardiovascular events despite the presence of arteriosclerotic cardiovascular disease and LDL-c levels. Aggressive medication regimens, PS and HS, appeared to be more effective, especially in patients with established CAD.https://www.mdpi.com/1999-4923/15/1/6systematic reviewbayesian network meta-analysisantidyslipidemia pharmacotherapychronic kidney disease |
| spellingShingle | Guangzhi Liao Xiangpeng Wang Yiming Li Xuefeng Chen Ke Huang Lin Bai Yuyang Ye Yong Peng Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis Pharmaceutics systematic review bayesian network meta-analysis antidyslipidemia pharmacotherapy chronic kidney disease |
| title | Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis |
| title_full | Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis |
| title_fullStr | Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis |
| title_full_unstemmed | Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis |
| title_short | Antidyslipidemia Pharmacotherapy in Chronic Kidney Disease: A Systematic Review and Bayesian Network Meta-Analysis |
| title_sort | antidyslipidemia pharmacotherapy in chronic kidney disease a systematic review and bayesian network meta analysis |
| topic | systematic review bayesian network meta-analysis antidyslipidemia pharmacotherapy chronic kidney disease |
| url | https://www.mdpi.com/1999-4923/15/1/6 |
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