Prevention of Chronic Kidney Disease and Subsequent Effect on Mortality: A Systematic Review and Meta-Analysis

Abstract

ObjectivesTo perform a systematic review of randomized controlled trials to determine whether prevention or slowing of progression of chronic kidney disease would translate into improved mortality, and if so, the attributable risk due to CKD itself on mortality.BackgroundCKD is associated with increased mortality. This association is largely based on evidence from the observational studies and evidence from randomized controlled trials is lacking.MethodsWe searched Ovid, Medline and Embase for RCTs in which an intervention was given to prevent or slow the progression of CKD and mortality was reported as primary, secondary or adverse outcomes were eligible and selected. For the first phase, pooled relative risks for renal endpoints were assessed. For the second phase, we assessed the effect on mortality in trials of interventions that definitively reduced CKD endpoints.ResultsAmong 52 studies selected in first phase, only renin-angiotensin-aldosterone-system blockade vs. placebo (n = 18 trials, 32,557 participants) met the efficacy criteria for further analysis in the second phase by reducing renal endpoints 15 to 27% compared to placebo. There was no difference in all-cause mortality (RR 0.99, 95% CI 0.92 to 1.08) or CV death (RR 0.97, 95% CI 0.78 to 1.21) between the treatment and control groups in these trials. There was sufficient statistical power to detect a 9% relative risk reduction in all-cause mortality and a 14% relative risk reduction in cardiovascular mortality.ConclusionsFirm evidence is lacking that prevention of CKD translates into reductions in mortality. Larger trials with longer follow-up time are needed to determine the benefit of CKD prevention on survival.

Haematuria Increases Progression of Advanced Proteinuric Kidney Disease

“…Haematuria is defined as the presence of red blood cells (RBCs) in urine. Haematuria is a common finding in various glomerular diseases, such as IgA nephropathy (IgAN), Alport syndrome and thin basement membrane disease [ 5 ]; however its presence is usually not mentioned in large epidemiological studies and little is known about its role on CKD progression [ 6 – 7 ]. After decades of considering haematuria as a benign clinical manifestation of glomerular diseases, without real consequences on renal function and long-term prognosis, new evidences pointed its negative implications on the progression of renal disease [ 8 – 9 ].…”

Evaluation of Continuous Positive Airway Pressure Therapy on Renin–Angiotensin System Activity in Obstructive Sleep Apnea

“…Limited studies suggest a prominent role of the RAS in the setting of chronic intermittent hypoxia (11)(12)(13), activation of which results in a predisposition to kidney and vascular disease (9). Multiple lines of evidence have underscored the importance of up-regulated RAS activity in both initiation and progression of kidney disease (14,15). However, reports on the association between OSA and the RAS in humans are conflicting (16)(17)(18)(19)(20)(21)(22).…”

Hematuria is a risk factor towards end-stage renal disease - A propensity score analysis

“…Although microscopic hematuria has been considered as a diagnostic marker of any kidney disease including glomerular diseases, its impact on CKD progression has not been investigated in many large epidemiological studies [23,24]. This fact may be in part due to the difficulty in assessing microscopic hematuria quantitatively [25,26].…”