Effectiveness And Safety Of Active Vitamin D In Patients With IgA Nephropathy: A Systematic Review Of Randomized Controlled Trials

Objective:Based on the domestic and foreign clinical trials related to activated vitamin D（VD）combined withangiotensinⅡreceptor blocker（ARB）treatment,this meta-analysis aims to explore the effectiveness and safety of active vitamin D combined with ARB treatment in IgA nephropathy.Methods:Electronic database searches was performed on the PubMed,Embase,Web of Science,The Cochrane Library,CBM,CNKI,VIP,Wan fang.Data from the beginning of the database to December,2017 were included.Languages are limited to Chinese and English.Randomized controlled trials in ARB combined activated vitamin D therapy for IgAN were selected and assessed for the methodological quality,and the extracted data were performed meta-analysis by statistical software Revman 5.3.Results:Eight studies,including 356 patients with IgAN,were included in this systemic review and meta-analysis.（1）Significant decrease in 24-hour urinary protein levels in vitamin D plus ARB compared to ARB treatment[MD=-305.00,95%CI（-357.25,-252.74）,P<0.00001].（2）The effect of ARB combined with active vitamin D treatment on serum creatinine was statistically significant in the short-term treatment group[MD=-15.16,95%CI（-26.41,-3.90）,P=0.008],but was not statistically significant in the long-term treatment group[MD=0.58,95%CI（-2.54,3.71）,P=0.72].（3）The effect of ARB combined with active vitamin D treatment on blood calcium wasgreaterthanthatofARBalone,thedifferencewasstatistically significant[MD=0.05,95%CI（0.02,0.07）,P=0.0006].（4）Compared with ARB treatment group,TGF-β₁[MD=-10.16,95%CI（-17.28,-3.04）,P=0.005]、CD4⁺[MD=-16.45,95%CI（-18.65,-14.24）,P<0.00001]、CD4⁺/CD8⁺[MD=-0.40,95%CI（-0.68,-0.12）,P=0.006]the level of active vitamin D plus ARB significantly decreased.（5）Serum potassium[MD=0.00,95%CI（-0.19,0.19）,P=1.00]and serum phosphorus[MD=0.03,95%CI（-0.05,0.11）,P=0.48]showed no significant difference.Conclusion:Compared with the use of ARB alone,the combination of active vitamin D has a better effect in reducing 24-hour urinary protein in patients with IgAN,but has a correspondingly greater effect on elevated serum calcium concentrations and should be monitored regularly.However,this result still needs a large-scale,multi-centered randomized controlled trial to confirm.