The association between the eGFR slope and cardiorenal prognosis in patients with renoprotective treatments: A systematic review and meta-analysis
Shuzhen Bai , Chu Lin , Xiaoling Cai , Han Wu , Ruoyang Jiao , Suiyuan Hu , Fang Lv , Wenjia Yang , Linong Ji
Journal of Evidence-Based Medicine ›› 2024, Vol. 17 ›› Issue (3) : 643 -653.
The association between the eGFR slope and cardiorenal prognosis in patients with renoprotective treatments: A systematic review and meta-analysis
Background: The associations between the estimated glomerular filtration rate (eGFR) slope and the cardiorenal prognosis in patients with renoprotective drugs have not been well characterized yet.
Methods: PubMed, Medline, Embase, The Cochrane Library, CNKI, WanFang, Weipu databases and Clinicaltrial.gov were searched from inception to April 2023. Event-driven randomized controlled trials (RCTs) investigating renoprotective drugs and reporting eGFR slopes in patients with atherosclerotic cardiovascular disease, heart failure, type 2 diabetes, or chronic kidney disease were included.
Results: In all, 25 RCTs with 179, 893 participants were included. The preservation of eGFR was observed in patients with renoprotective drugs, with a comparator-adjusted total eGFR slope of 0.51 mL/min per 1.73 m2/year (95% CI, 0.31 to 0.70). It was indicated that the eGFR preservation reflected by the positive comparator-adjusted total eGFR slope was associated with a reduced risk of composite renal outcome (β = −0.097, 95% CI, -0.178 to -0.016,p = 0.022), but was not associated with the risks of major adverse cardiovascular events (MACE) or all-cause mortality. In patients with SGLT2i, MRA, or RAASi treatments, the placebo-adjusted acute eGFR slope was -0.59 mL/min per 1.73 m2 per week (95% CI, -0.74 to -0.43), which was marginally associated with a reduced risk of composite renal outcome (β = 0.290, 95% CI, 0.000 to 0.581,p = 0.050), but was not associated with the risks of MACE or all-cause mortality.
Conclusions: The eGFR preservation reflected by the positive comparator-adjusted total eGFR slope was associated with a reduced risk of composite renal outcome in patients receiving renoprotective agents. Greater acute decline in eGFR during the initiation of the treatment might confer a trend of fewer renal events in patients receiving SGLT2i, MRA, or RAASi.
cardiovascular outcome / chronic kidney disease / estimated glomerular filtration rate / renal outcome
2024 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.
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