| Objective:1.Analyze the effect of active vitamin D on proteinuria in patients with chronic kidney disease,in order to provide a reference for clinical treatment.2.To investigate the effect and efficacy of active vitamin D on moderate and small proteinuria,and to analyze the effects of active vitamin D on blood pressure(BP),estimated glomerular filtration rate(eGFR),blood calcium(Ca),blood phosphorus(P),and blood parathyroid hormone(PTH).3.Explore whether active vitamin D and RAAS inhibitors can reduce proteinuria synergistically.Methods:1.We searched the electronic retrieval databases,including CBM,CNKI,VIP,WANFANG,PubMed,Embase and Cochrane libraries.The published randomized controlled trials(RCTs)of the effects of active vitamin D on proteinuria was performed from January 2000 to June 2019.The trails were extracted data and screened according to the inclusion and exclusion criteria by two reviewers.The quality of included randomized controlled trials was assessed using the Cochrane collaboration's tool for assessing the risk of bias.Review Manager 5.3 software was used for statistical analysis of the included literatures.2.A total of 119 patients with moderate and small proteinuria admitted to the first affiliated hospital of suzhou university from September 2016 to June 2018 were collected.They were patients with primary glomerular disease.These patients were divided into three groups randomly.Group A received calcitriol 0.25 ?g/d combined with valsartan 80 mg/day,group B only received calcitriol 0.25 ?g/d,and group C only received valsartan 80 mg/day.Some baseline levels of clinical indicators were recorded prior to treatment.These clinical indicators include the total protein content in urine at 24 hours(24hUTP),urinary proteinuria creatinine ratio(TP/Cr-U),blood pressure,serum calcium,serum phosphorus,25-hydroxyvitamin D3,parathyroid hormone,alkaline phosphatase,high-sensitivity C-reactive protein,etc.Then follow up every four weeks,these indicators were detected during the follow-up such as BP,24hUTP,TP/Cr-U,etc.The baseline indicators were tested again after 24 weeks of follow-up.Compare the difference between the study endpoint and the baseline of 24hUTP,and compare the reduction of 24hUTP in the three groups.Proteinuria change rate is calculated by dividing the amount of proteinuria change by the baseline value of proteinuria.Compare the differences in the three groups of the change rates.Finally,compare the differences between before and after treatment in blood pressure,serum calcium,serum phosphorus,25-hydroxyvitamin D3,parathyroid hormone,serum alkaline phosphatase,serum high-sensitivity C-reactive protein,etc.Results:1.Meta-analysis:752 relevant literatures were retrieved,and 9 literatures were finally selected,including 990 patients.Among them,496 patients(50.10%)received active vitamin D combined with conventional treatment or active vitamin D alone(experimental group),and 494 patients(49.90%)received conventional treatment or placebo or other treatment(control group).Proteinuria in the experimental group after active vitamin D treatment was lower than that in the control group[Mean Difference(MD)=-0.52,95%CI(-0.74,-0.30),P<0.00001],and the Difference was statistically significant.In addition,serum creatinine(Scr)level in the experimental group was significantly lower than that in the control group[MD=-23.63,95%CI(-35.06,-12.20),P<0.0001],and the difference was statistically significant.2.Clinical research:(1)After 24 weeks of treatment,the levels of proteinuria decreased in the three groups.The 24hUTP of group A decreased from 1.16±0.46 g to 0.72±0.42 g(P<0.05),group B decreased from 1.05±0.41 g to 0.77±0.35 g(P<0.05),and the group C decreased from 0.97±0.49 g to 0.69±0.39 g(P<0.05).(2)The difference in protein change rate between group A and group B was significant statistically(P=0.019).The difference between group A and group C was not significant statistically(P=0.088).And the difference was not significant statistically between group B and group C.(P=0.541).(3)There was no significant difference in serum calcium,serum phosphorus,ALP,25-(OH)D3 and PTH between group A and group B(P>0.05).And there was no significant difference in serum calcium,serum phosphorus and ALP before and after treatment in group C.(P>0.05).(4)The hs-CRP decreased in the three groups after treatment.Group A decreased from 1.46±0.63mg/L to 1.25±0.49mg/L(P==0.002),group B decreased from 1.44±0.43mg/L to 1.26.±0.34mg/L(P=0.023),and group C decreased from 1.46±0.64mg/L to 1.39±0.51mg/L(P=0.173).The decrease of hs-CRP in group A and group B was significant statistically between before and after treatment.Conclusion:1.This meta-analysis shows that active vitamin D can reduce proteinuria and improve renal function in patients with chronic kidney disease.2.Clinical research:(1)Active vitamin D has the effect of reducing moderate and small albuminuria in patients with chronic kidney disease.(2)Combined application of active vitamin D and ARB drugs has a more significant effect on reducing albuminuria than active vitamin D alone.(3)There was no significant difference in blood pressure and estimated glomerular filtration rate of patients before and after treatment,suggesting that the effect of active vitamin D on reducing albuminuria may not depend on changes in blood pressure and eGFR.(4)There were no significant differences in Ca,P,ALP,25-(OH)D3 and PTH before and after treatment,suggesting that active vitamin D may not affect the normal calcium and phosphorus metabolism of patients while reducing proteinuria.(5)Active vitamin D can reduce hs-CRP,suggesting that it may reduce inflammatory factors and inhibit inflammatory response. |
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