Treatment Of Diabetic Nephropathy With Calcitriol:a Meta-analysis

Objective:Based on the Meta-analysis of the randomized clinical controlled trials of angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor blocker(ARB)treatment at home and abroad,the study is aimed at exploring the effectiveness and safety of calcitriol combined ACEI or ARB in the treatment of diabetic nephropathy(DN)patients.Methods:Searches were performed on all the Chinese and English data of Cochrane clinical library,PUBMED,Wanfang,VIP,CNKI and CBM from the start of the database to January 2017.Clinical randomized controlled trials were selected,which conforms to the standard of inclusion and exclusion preset.Information were extracted from the inclusion of the standard data.The content of the extraction includes: the author of the data,publication time,stochastic method,the basic information of the object of the study,intervention used,dose,course of treatment,the observation target of the outcome and side effects.Revised JADA was used to evaluate the extracted data and statistical software Revman5.2 was used to analyze the extracted information through Meta analysis.Results:After searching and accurate selection of data,23 standard clinical randomized controlled trials were chosen,including 1,732 patients among which there were 867 patients in experimental group and 865 patients in controlled group.The Meta-analysis shows that calcitriol combined with ACEI or ARB can evidently decrease 24-hours proteinuria [P<0.00001,MD=-0.43,95%CI(-0.50,-0.35)] and microalbuminuria [P<0.00001,MD=-36.94,95% CI(-39.08,-34.80)] in comparison with ACEI or ARB independently used for treating diabetic nephropathy,which might increase the incidence rate of phosphorus in blood [P=0.02,MD=0.03,95% CI(0.00,0.06)],and no statistical differences of blood calcium [P=0.79,MD=0,95% CI(-0.03,-0.04)],potassium in blood [P=0.19,MD=-0.06,95% CI(-0.14,-0.03)],systolic blood pressure [P=0.22,MD=-1.55,95% CI(-4.03,0.93)],and diastolic blood pressure [P=0.37,MD=-0.71,95% CI(-2.25,0.83)],and no statistical differences of incidence rate of side effects [P=0.71,OR=0.87,95% CI(0.43,1.77)].Conclusion:Compared with ACEI or ARB used independently,combined calcitriol is more remarkable than 24-hours proteinuria and microalbuminuria in the treatment of diabetic nephropathy.However,it may raise the incidence rate of increase of the phosphorus in blood,and lead to no obvious effect on blood calcium and potassium in blood,and no obvious effect on the control level of patients’ blood pressure(systolic blood pressure and diastolic blood pressure),and on the statistics of untoward effect.Owing to the differences among patients chosen by randomized clinical controlled trials and differences in the application of calcitriol in dose and course of treatment.The conclusion remains to be verified by large-scale,multicenter,and prospective randomized controlled trials.