The Effect Of Active Vitamind On Cardiovascular Outcomes In Predialysis Chronic Kidney Diseases:a Systemetic Review And Meta-Analysis

Aims:Vitamin D deficient patients present a higher risk of cardiovascular disease. We conducted this systematic review and meta-analysis to evaluate the effect of active vitamin D analog on cardiovascular outcomes in predialysis chronic kidney disease.Methods:Pubmed, MEDLINE, Embase, the Cochrane Library, CNKI, and article reference lists were searched for RCTs that compared active vitamin D analog with placebo or no treatment for patients with predialysis chronic kidney disease. Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager Software, ver.5.2, was used for meta-analysis.Results:Eight RCTs (six studies with paricalcitol and two studies with calcitriol,757 patients) were included. Compared with controls groups, active vitamin D reduced the incidence of cardiovascular events (RR,0.25; 95%CI, 0.12-0.52), induced a reduction in proteinuria (RR,1.63; 95%CI,1.35-1.96), but did not alter left ventricular mass index and systolic function (MD,0.42 g/m2.7; 95%CI,-0.23-1.07 g/m2.7, P=0.21 for left ventricular mass index and MD,-0.33; 95%CI,-0.74-0.07, P=0.1 for left ventricular ejection fraction). Neither systolic blood pressure nor diastolic blood pressure was reduced by active vitamin D(MD,-0.79 mmHg; 95%CI,-4.14-2.57mmHg; MD,-0.83 mmHg; 95%CI:-3.80-2.13 mmHg, respectively). Increased probability of hypercalcemia after paricalcitol therapy was found (RR7.85,95%CI,2.92-21.1)。Conclusion:Active vitamin D reduced the incidence of cardiovascular events and induced a reduction in proteinuria, but its long-term effect on cardiac structure and function needed further confirmation, and its effect on blood pressure and eGFR needed more researches.