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JACC：贝特类药物可降低慢性肾病患者心血管事件发生的风险

2013-01-28 JACC CMT Alexa 译

慢性肾脏疾病心血管事件
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　　研究表明：在慢性肾脏疾病(CKD)患者中，贝特类药物可改善血脂谱、预防心血管事件的发生。 贝特类药物可减少白蛋白尿并可逆性升高血清肌酐水平，但其对肾脏预后的作用尚不明确。 贝特类药物可有效降低中度CKD患者心血管事件发生的风险。 　　心血管疾病是慢性肾病 (CKD) 患者死亡的首要原因。 研究人员对16,869名CKD患者进行一项分析，比较了

　　研究表明：在慢性肾脏疾病(CKD)患者中，贝特类药物可改善血脂谱、预防心血管事件的发生。 贝特类药物可减少白蛋白尿并可逆性升高血清肌酐水平，但其对肾脏预后的作用尚不明确。 贝特类药物可有效降低中度CKD患者心血管事件发生的风险。

　　心血管疾病是慢性肾病 (CKD) 患者死亡的首要原因。 研究人员对16,869名CKD患者进行一项分析，比较了贝特类药物疗法与安慰剂治疗的使用情况。研究结果显示，轻中度CKD患者中，重大心血管事件和心血管死亡的风险分别下降了30%和40%。贝特类药物疗法可显著降低总胆固醇和甘油三酯并升高高密度脂蛋白 (HDL) 胆固醇，但对低密度脂蛋白 (LDL) 胆固醇无影。在伴糖尿病的CKD患者中，贝特类药物疗法可延缓降蛋白尿的进展。


Objectives
The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of fibrate therapy in the chronic kidney disease (CKD) population.
Background
Fibrate therapy produces modest cardiovascular benefits in people at elevated cardiovascular risk. There is limited evidence about the clinical benefits and safety of fibrate therapy in the CKD population.
Methods
MEDLINE, EMBASE, and the Cochrane Library were systematically searched (1950 to January 2012) for prospective randomized controlled trials assessing the effects of fibrate therapy compared with placebo in people with CKD or on kidney-related outcomes were included.
Results
Ten studies including 16,869 participants were identified. In patients with mild-to-moderate CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min/1.73 m2), fibrates improved lipid profiles (lowered total cholesterol [−0.32 mmol/l, p = 0.05] and triglyceride levels [−0.56 mmol/l, p = 0.03] but not low-density lipoprotein cholesterol [−0.01 mmol/l, p = 0.83]; increased high-density lipoprotein cholesterol [0.06 mmol/l, p = 0.001]). In people with diabetes, fibrates reduced the risk of albuminuria progression (relative risk [RR]: 0.86; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.02). Serum creatinine was elevated by fibrate therapy (33 μmol/l, p < 0.001), calculated GFR was reduced (−2.67 ml/min/1.73 m2, p = 0.01) but there was no detectable effect on the risk of end-stage kidney disease (RR: 0.85; 95% CI: 0.49 to 1.49; p = 0.575). In patients with eGFR of 30 to 59.9 ml/min/1.73 m2, fibrates reduced the risk of major cardiovascular events (RR: 0.70; 95% CI: 0.54 to 0.89; p = 0.004) and cardiovascular death (RR: 0.60; 95% CI: 0.38 to 0.96; p = 0.03) but not all-cause mortality. There were no clear safety concerns specific to people with CKD but available data were limited.
Conclusions
Fibrates improve lipid profiles and prevent cardiovascular events in people with CKD. They reduce albuminuria and reversibly increase serum creatinine but the effects on major kidney outcomes remain unknown. These results suggest that fibrates have a place in reducing cardiovascular risk in people with mild-to-moderate CKD.     
       


    

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2055919, encodeId=9038205591969, content=<a href='/topic/show?id=d088536467a' target=_blank style='color:#2F92EE;'>#慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53646, encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Sun Aug 04 09:27:00 CST 2013, time=2013-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643302, encodeId=7a4d16433029d, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Fri Jan 03 06:27:00 CST 2014, time=2014-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025764, encodeId=2b8b2025e64ab, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Fri May 03 00:27:00 CST 2013, time=2013-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853214, encodeId=b252185321423, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Tue Mar 12 06:27:00 CST 2013, time=2013-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1813348, encodeId=0b731813348b8, content=<a href='/topic/show?id=0344922297e' target=_blank style='color:#2F92EE;'>#贝特类药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92229, encryptionId=0344922297e, topicName=贝特类药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Tue Apr 16 19:27:00 CST 2013, time=2013-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1324800, encodeId=a25a1324800e0, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Wed Jan 30 06:27:00 CST 2013, time=2013-01-30, status=1, ipAttribution=)]
    2013-08-04 snowpeakxu

    #慢性肾病患者#

    0

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    2014-01-03 hukaixun

    #血管事件#

    0

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    2013-05-03 gostraight

    #肾病患者#

    0

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    2013-03-12 hbwxf

    #JACC#

    0

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    2013-04-16 tsing_hit

    #贝特类药物#

    0

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    2013-01-30 12498568m50暂无昵称

    #ACC#

    0

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