Rodriguez RA, Spence M, Hae R, Agharazii M, Burns KD. Pharmacologic Therapies for Aortic Stiffness in End-Stage Renal Disease: A Systematic Review and Meta-Analysis.
Can J Kidney Health Dis 2020;
7:2054358120906974. [PMID:
32128224 PMCID:
PMC7036505 DOI:
10.1177/2054358120906974]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background:
Increased carotid-femoral pulse wave velocity (cf-PWV), a surrogate of
increased aortic stiffness, is a risk factor for cardiovascular events and
all-cause mortality in end-stage renal disease (ESRD). To minimize the
deleterious effects of an increased aortic stiffness in ESRD patients,
several interventions have been developed and cf-PWV has been used to
monitor responses.
Objective:
The aim of this study was to determine the effects of pharmacologic
interventions that target aortic stiffness on cf-PWV and systolic blood
pressure (SBP) in adults with ESRD.
Study design:
This study implements a systematic review and meta-analysis.
Data sources:
MEDLINE, EMBASE, Cochrane Central, Health Technology Assessment, and EBM
databases were searched.
Study eligibility, participants, and interventions:
Randomized and non-randomized studies involving adults (>18 years) with
ESRD of any duration, receiving or not renal replacement therapy
(hemodialysis, peritoneal dialysis) and exposed to a pharmacologic
intervention whose effects were assessed by cf-PWV.
Methods:
Study screening, selection, data extraction, and quality assessments were
performed by 2 independent reviewers. Narrative synthesis and quantitative
data analysis summarized the review.
Results:
We included 1027 ESRD participants from 13 randomized and 5 non-randomized
studies. Most pharmacologic interventions targeted bone mineral metabolism
disorder or hypertension. Treatment with vitamin D analogues or cinacalcet
did not decrease cf-PWV or SBP over placebo or matched controls
(P > .05). Calcium-channel blockers (CCB) decreased
cf-PWV and SBP compared with placebo or standard care (P
< .05). Renin-angiotensin system inhibitors did not show any advantage
over placebo in decreasing cf-PWV (P > .05).
Limitations:
Quality of evidence ranged from very low to moderate. Overall evidence was
limited by the low number of studies, small sample sizes, and methodological
inconsistencies.
Conclusions:
Pharmacologic interventions targeting aortic stiffness in ESRD have mixed
effects on reducing cf-PWV, with some strategies suggesting potential
benefit. The quality of evidence, however, is insufficient to draw
definitive conclusions on their use to slow progression of aortic stiffness
in ESRD. Further well-designed studies are needed to confirm these
associations and their impact on cardiovascular outcomes in ESRD.
Registered in PROSPERO (CRD42016033463)
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