Treatment of diabetic kidney disease. A network meta-analysis
Diabetic kidney disease (DKD) is a health burden of rising importance. Slowing progression to end stage kidney disease is the main goal of drug treatment. The aim of this analysis is to compare drug treatments of DKD by means of a systemic review and a network meta-analysis. We searched Medline, CEN...
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| description | Diabetic kidney disease (DKD) is a health burden of rising importance. Slowing progression to end stage kidney disease is the main goal of drug treatment. The aim of this analysis is to compare drug treatments of DKD by means of a systemic review and a network meta-analysis. We searched Medline, CENTRAL and clinicaltrials.gov for randomized, controlled studies including adults with DKD treated with the following drugs of interest: single angiotensin-converting-enzyme-inhibitor or angiotensin-receptor-blocker (single ACEi/ARB), angiotensin-converting-enzyme-inhibitor and angiotensin-receptor-blocker combination (ACEi+ARB combination), aldosterone antagonists, direct renin inhibitors, non-steroidal mineralocorticoid-receptor-antagonists (nsMRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i). As primary endpoints, we defined: overall mortality and end-stage kidney disease, as secondary endpoints: renal composite outcome and albuminuria and as safety endpoints: acute kidney injury, hyperkalemia and hypotension. Under the use of a random effects model, we computed the overall effect estimates using the statistic program R4.1 and the corresponding package "netmeta". Risk of bias was assessed using the RoB 2 tool and the quality of evidence of each pairwise comparison was rated according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Of initial 3489 publications, 38 clinical trials were found eligible, in total including 42346 patients. Concerning the primary endpoints overall mortality and end stage kidney disease, SGLT2i on top of single ACEi/ARB compared to single ACEi/ARB was the only intervention significantly reducing the odds of mortality (OR 0.81, 95%CI 0.70-0.95) and end-stage kidney disease (OR 0.69, 95%CI 0.54-0.88). The indirect comparison of nsMRA vs SGLT2i in our composite endpoint suggests a superiority of SGLT2i (OR 0.60, 95%CI 0.47-0.76). Concerning safety endpoints, nsMRA and SGLT2i showed benefits compared to the others. As the only drug class, SGLT2i showed in our analysis beneficial effects on top of ACEi/ARB treatment regarding mortality and end stage kidney disease and by that reconfirmed its position as treatment option for diabetic kidney disease. nsMRA reduced the odds for a combined renal endpoint and did not raise any safety concerns, justifying its application. |
| doi_str_mv | 10.1371/journal.pone.0293183 |
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We searched Medline, CENTRAL and clinicaltrials.gov for randomized, controlled studies including adults with DKD treated with the following drugs of interest: single angiotensin-converting-enzyme-inhibitor or angiotensin-receptor-blocker (single ACEi/ARB), angiotensin-converting-enzyme-inhibitor and angiotensin-receptor-blocker combination (ACEi+ARB combination), aldosterone antagonists, direct renin inhibitors, non-steroidal mineralocorticoid-receptor-antagonists (nsMRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i). As primary endpoints, we defined: overall mortality and end-stage kidney disease, as secondary endpoints: renal composite outcome and albuminuria and as safety endpoints: acute kidney injury, hyperkalemia and hypotension. Under the use of a random effects model, we computed the overall effect estimates using the statistic program R4.1 and the corresponding package "netmeta". Risk of bias was assessed using the RoB 2 tool and the quality of evidence of each pairwise comparison was rated according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Of initial 3489 publications, 38 clinical trials were found eligible, in total including 42346 patients. Concerning the primary endpoints overall mortality and end stage kidney disease, SGLT2i on top of single ACEi/ARB compared to single ACEi/ARB was the only intervention significantly reducing the odds of mortality (OR 0.81, 95%CI 0.70-0.95) and end-stage kidney disease (OR 0.69, 95%CI 0.54-0.88). The indirect comparison of nsMRA vs SGLT2i in our composite endpoint suggests a superiority of SGLT2i (OR 0.60, 95%CI 0.47-0.76). Concerning safety endpoints, nsMRA and SGLT2i showed benefits compared to the others. As the only drug class, SGLT2i showed in our analysis beneficial effects on top of ACEi/ARB treatment regarding mortality and end stage kidney disease and by that reconfirmed its position as treatment option for diabetic kidney disease. nsMRA reduced the odds for a combined renal endpoint and did not raise any safety concerns, justifying its application.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0293183</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>ACE inhibitors ; Aldosterone ; Analysis ; Angiotensin ; Biology and Life Sciences ; Care and treatment ; Chronic kidney failure ; Clinical trials ; Complications and side effects ; Corticosteroids ; Data analysis ; Development and progression ; Dextrose ; Diabetes ; Diabetes mellitus ; Diabetic nephropathies ; Diagnosis ; Drugs ; End-stage renal disease ; Enzymes ; Estimates ; Evaluation ; Evidence-based medicine ; Germany ; Glucose ; Health aspects ; Health services ; Hyperkalemia ; Hypotension ; Inhibitors ; Intervention ; Kidney diseases ; Kidneys ; Medicine and Health Sciences ; Meta-analysis ; Mortality ; Peptidyl-dipeptidase A ; Physical Sciences ; Receptors ; Renal replacement therapy ; Renin ; Research and Analysis Methods ; Risk factors ; Safety ; Sodium ; Sodium-glucose cotransporter ; Statistical analysis</subject><ispartof>PloS one, 2023-11, Vol.18 (11), p.e0293183-e0293183</ispartof><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Büttner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Büttner et al 2023 Büttner et al</rights><rights>2023 Büttner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c670t-89826af13b604aae02053ff735e95f09d64244109b83801ed6da4ef20ad2c01e3</citedby><cites>FETCH-LOGICAL-c670t-89826af13b604aae02053ff735e95f09d64244109b83801ed6da4ef20ad2c01e3</cites><orcidid>0000-0002-8769-9752</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621862/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621862/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids></links><search><creatorcontrib>Büttner, Fabian</creatorcontrib><creatorcontrib>Barbosa, Clara Vollmer</creatorcontrib><creatorcontrib>Lang, Hannah</creatorcontrib><creatorcontrib>Tian, Zhejia</creatorcontrib><creatorcontrib>Melk, Anette</creatorcontrib><creatorcontrib>Schmidt, Bernhard M. W</creatorcontrib><title>Treatment of diabetic kidney disease. A network meta-analysis</title><title>PloS one</title><description>Diabetic kidney disease (DKD) is a health burden of rising importance. Slowing progression to end stage kidney disease is the main goal of drug treatment. The aim of this analysis is to compare drug treatments of DKD by means of a systemic review and a network meta-analysis. We searched Medline, CENTRAL and clinicaltrials.gov for randomized, controlled studies including adults with DKD treated with the following drugs of interest: single angiotensin-converting-enzyme-inhibitor or angiotensin-receptor-blocker (single ACEi/ARB), angiotensin-converting-enzyme-inhibitor and angiotensin-receptor-blocker combination (ACEi+ARB combination), aldosterone antagonists, direct renin inhibitors, non-steroidal mineralocorticoid-receptor-antagonists (nsMRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i). 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The indirect comparison of nsMRA vs SGLT2i in our composite endpoint suggests a superiority of SGLT2i (OR 0.60, 95%CI 0.47-0.76). Concerning safety endpoints, nsMRA and SGLT2i showed benefits compared to the others. As the only drug class, SGLT2i showed in our analysis beneficial effects on top of ACEi/ARB treatment regarding mortality and end stage kidney disease and by that reconfirmed its position as treatment option for diabetic kidney disease. nsMRA reduced the odds for a combined renal endpoint and did not raise any safety concerns, justifying its application.</description><subject>ACE inhibitors</subject><subject>Aldosterone</subject><subject>Analysis</subject><subject>Angiotensin</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Clinical trials</subject><subject>Complications and side effects</subject><subject>Corticosteroids</subject><subject>Data analysis</subject><subject>Development and progression</subject><subject>Dextrose</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic nephropathies</subject><subject>Diagnosis</subject><subject>Drugs</subject><subject>End-stage renal disease</subject><subject>Enzymes</subject><subject>Estimates</subject><subject>Evaluation</subject><subject>Evidence-based medicine</subject><subject>Germany</subject><subject>Glucose</subject><subject>Health aspects</subject><subject>Health services</subject><subject>Hyperkalemia</subject><subject>Hypotension</subject><subject>Inhibitors</subject><subject>Intervention</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Peptidyl-dipeptidase A</subject><subject>Physical Sciences</subject><subject>Receptors</subject><subject>Renal replacement therapy</subject><subject>Renin</subject><subject>Research and Analysis Methods</subject><subject>Risk factors</subject><subject>Safety</subject><subject>Sodium</subject><subject>Sodium-glucose cotransporter</subject><subject>Statistical analysis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl2L1DAUhosouK7-A8GCIHoxNV-TJhciw-LHwMKCrt6GND2ZyWzbjEmqzr8341TZyl5ILpKTPOc9eQ-nKJ5iVGFa49c7P4ZBd9XeD1AhIikW9F5xhiUlC04QvX_r_LB4FOMOoSUVnJ8Vb64D6NTDkEpvy9bpBpIz5Y1rBzjkOIKOUJWrcoD0w4ebsoekFzpXO0QXHxcPrO4iPJn28-LL-3fXFx8Xl1cf1hery4XhNUoLIQXh2mLacMS0BkRyeWtrugS5tEi2nBHGMJKNoAJhaHmrGViCdEtMjul58eyku-98VJPdqCjiEktMJMnE-kS0Xu_UPrheh4Py2qnfFz5slA7ZWQfKSMIkA0OsaBijdaOFlG3DlpJYyw3NWm-namPTQ2tyc4LuZqLzl8Ft1cZ_VxhxggU__ublpBD8txFiUr2LBrpOD-DHqIgQnBIuucjo83_Qu-1N1EZnB26wPhc2R1G1qmtMcC1qlqnqDiqvFnpn8nBYl-9nCa9mCZlJ8DNt9BijWn_-9P_s1dc5--IWuwXdpW303ZicH-IcZCfQBB9jAPu3yxip42z_6YY6zraaZpv-Aq5F6gM</recordid><startdate>20231102</startdate><enddate>20231102</enddate><creator>Büttner, Fabian</creator><creator>Barbosa, Clara Vollmer</creator><creator>Lang, Hannah</creator><creator>Tian, Zhejia</creator><creator>Melk, Anette</creator><creator>Schmidt, Bernhard M. 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W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of diabetic kidney disease. A network meta-analysis</atitle><jtitle>PloS one</jtitle><date>2023-11-02</date><risdate>2023</risdate><volume>18</volume><issue>11</issue><spage>e0293183</spage><epage>e0293183</epage><pages>e0293183-e0293183</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Diabetic kidney disease (DKD) is a health burden of rising importance. Slowing progression to end stage kidney disease is the main goal of drug treatment. The aim of this analysis is to compare drug treatments of DKD by means of a systemic review and a network meta-analysis. 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Risk of bias was assessed using the RoB 2 tool and the quality of evidence of each pairwise comparison was rated according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Of initial 3489 publications, 38 clinical trials were found eligible, in total including 42346 patients. Concerning the primary endpoints overall mortality and end stage kidney disease, SGLT2i on top of single ACEi/ARB compared to single ACEi/ARB was the only intervention significantly reducing the odds of mortality (OR 0.81, 95%CI 0.70-0.95) and end-stage kidney disease (OR 0.69, 95%CI 0.54-0.88). The indirect comparison of nsMRA vs SGLT2i in our composite endpoint suggests a superiority of SGLT2i (OR 0.60, 95%CI 0.47-0.76). Concerning safety endpoints, nsMRA and SGLT2i showed benefits compared to the others. As the only drug class, SGLT2i showed in our analysis beneficial effects on top of ACEi/ARB treatment regarding mortality and end stage kidney disease and by that reconfirmed its position as treatment option for diabetic kidney disease. nsMRA reduced the odds for a combined renal endpoint and did not raise any safety concerns, justifying its application.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><doi>10.1371/journal.pone.0293183</doi><tpages>e0293183</tpages><orcidid>https://orcid.org/0000-0002-8769-9752</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_3069191292 |
| source | Public Library of Science (PLoS) Journals Open Access; PMC (PubMed Central); DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Free Full-Text Journals in Chemistry |
| subjects | ACE inhibitors Aldosterone Analysis Angiotensin Biology and Life Sciences Care and treatment Chronic kidney failure Clinical trials Complications and side effects Corticosteroids Data analysis Development and progression Dextrose Diabetes Diabetes mellitus Diabetic nephropathies Diagnosis Drugs End-stage renal disease Enzymes Estimates Evaluation Evidence-based medicine Germany Glucose Health aspects Health services Hyperkalemia Hypotension Inhibitors Intervention Kidney diseases Kidneys Medicine and Health Sciences Meta-analysis Mortality Peptidyl-dipeptidase A Physical Sciences Receptors Renal replacement therapy Renin Research and Analysis Methods Risk factors Safety Sodium Sodium-glucose cotransporter Statistical analysis |
| title | Treatment of diabetic kidney disease. A network meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T15%3A29%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Treatment%20of%20diabetic%20kidney%20disease.%20A%20network%20meta-analysis&rft.jtitle=PloS%20one&rft.au=B%C3%BCttner,%20Fabian&rft.date=2023-11-02&rft.volume=18&rft.issue=11&rft.spage=e0293183&rft.epage=e0293183&rft.pages=e0293183-e0293183&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0293183&rft_dat=%3Cgale_plos_%3EA771217874%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3069191292&rft_id=info:pmid/&rft_galeid=A771217874&rft_doaj_id=oai_doaj_org_article_c92494ec2f8b4437ba899db4592ff6c3&rfr_iscdi=true |