Meta Analysis Of The Therapeutic Effect Of Active Vitamin D And Its Analogues On Type 2 Diabetic Kidney Disease

Objective To systematically evaluate the efficacy of active vitamin D and its analogues in the treatment of type 2 kidney disease(Type 2 Diabetic Kidney Disease,T2DKD).Methods Pubmed,Cochrane,Embase,Wanfang,CKNI,CBM,VIP and other databases were searched by computer,covering the period from self-built to February 2021.The published randomized controlled trials(Randomized controlled trial,RCT)of active vitamin D in the treatment of T2 DKD at home and abroad were collected,and the literatures were screened according to the inclusion and exclusion criteria.The quality of RCT studies that meet the criteria were evaluated with Jadad modified version scale and Cochrane risk assessment.The relevant data were extracted and meta analysis was carried out by using Stata15.1 software.Results Finally,16 articles were included,including 18 RCT studies,involving 1275 patients with T2 DKD,all of whom were treated with conventional therapy such as hypoglycemia and hypotension.The treatment group was treated with active vitamin D or its analogues,and the control group was treated with routine treatment or placebo.The results of Meta analysis showed that in terms of urinary protein,the active vitamin D group decreased urinary albumin/creatinine ratio [SMD=-0.76,95%CI(-0.92,-0.61),P=0.000],urinary albumin excretion rate [SMD=-0.81,95%CI(-0.98,-0.63),P=0.000]and 24-hour urinary protein [SMD=-0.56,95%CI(-0.78,-0.34),P< 0.001] than those in the control group.In terms of renal function,active vitamin D could not significantly increase glomerular filtration rate [SMD=0.15,95%CI(-0.04,0.34),P=0.119] and reduce serum creatinine [SMD=-0.09,95%CI(-0.30,0.12),P=0.416].In terms of parathyroid hormone and the regulation of calcium and phosphorus,active vitamin D could reduce parathyroid hormone levels [SMD=-1.25,95%CI(-2.16,0.34),P=0.007],there was no significant difference in serum calcium [SMD=0.22,95%CI(-0.17,0.61),P=0.274] and phosphorus [SMD=0.01,95%CI(-0.21,0.22),P=0.962] between the two groups.In addition,active vitamin D could also significantly reduce the inflammatory indexes of interleukin-6 [SMD=-0.83,95%CI(-1.17,-0.49),P=0.000],tumor necrosis factor-α[SMD=-0.99,95%CI(-1.20,-0.78),P=0.000],and C-reactive protein [SMD=-0.96,95%CI(-1.17,-0.75),P<0.001].Conclusion Active vitamin D and its analogues can reduce urinary protein,parathyroid hormone and related inflammatory indexes in patients with T2 DKD,and do not significantly affect the level of calcium and phosphorus,but can not significantly improve renal function in a short time,and the safety needs further study.