Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials
Vascular calcification is associated with cardiovascular morbidity and mortality in people with CKD. Evidence-based interventions that may attenuate its progression in CKD remain uncertain. We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcifi...
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Veröffentlicht in: | Journal of the American Society of Nephrology 2022-05, Vol.33 (5), p.1011-1032 |
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description | Vascular calcification is associated with cardiovascular morbidity and mortality in people with CKD. Evidence-based interventions that may attenuate its progression in CKD remain uncertain.
We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compared with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiologic methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal.
Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration. |
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We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compared with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiologic methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal.
Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration.</description><identifier>ISSN: 1046-6673</identifier><identifier>EISSN: 1533-3450</identifier><identifier>DOI: 10.1681/asn.2021101327</identifier><identifier>PMID: 35232774</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Clinical Research ; Female ; Humans ; Magnesium ; Male ; Prospective Studies ; Renal Dialysis ; Renal Insufficiency, Chronic - drug therapy ; Renal Insufficiency, Chronic - therapy ; Vascular Calcification - etiology</subject><ispartof>Journal of the American Society of Nephrology, 2022-05, Vol.33 (5), p.1011-1032</ispartof><rights>Copyright © 2022 by the American Society of Nephrology.</rights><rights>Copyright © 2022 by the American Society of Nephrology 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-56dc48dc8534e3c782c7a3b647c09d2f044f1c523e4f269c4fb8e443285bdae23</citedby><cites>FETCH-LOGICAL-c456t-56dc48dc8534e3c782c7a3b647c09d2f044f1c523e4f269c4fb8e443285bdae23</cites><orcidid>0000-0002-2651-1787 ; 0000-0001-9348-4638</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/PMC9063901/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9063901/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35232774$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xu, Chelsea</creatorcontrib><creatorcontrib>Smith, Edward R</creatorcontrib><creatorcontrib>Tiong, Mark K</creatorcontrib><creatorcontrib>Ruderman, Irene</creatorcontrib><creatorcontrib>Toussaint, Nigel D</creatorcontrib><title>Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials</title><title>Journal of the American Society of Nephrology</title><addtitle>J Am Soc Nephrol</addtitle><description>Vascular calcification is associated with cardiovascular morbidity and mortality in people with CKD. Evidence-based interventions that may attenuate its progression in CKD remain uncertain.
We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compared with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiologic methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal.
Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration.</description><subject>Clinical Research</subject><subject>Female</subject><subject>Humans</subject><subject>Magnesium</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Renal Dialysis</subject><subject>Renal Insufficiency, Chronic - drug therapy</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>Vascular Calcification - etiology</subject><issn>1046-6673</issn><issn>1533-3450</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUtP3DAUha2qCOjAliXysptM_Yrj6QJpFFpAoBaVabeWx7kBVxl7sJOpZsVfxxGUx-oe6X73eRA6omRKpaJfTPJTRhilhHJWfUD7tOS84KIkH7MmQhZSVnwPfUrpLyG0ZFW1i_Z4yTJdiX30cOF7iBvwvQs-4UXA874HP5ge8B-T7NCZiGvTWdc6a0YIX8dwGyGlUTuP67sYvLP40jUetvjUJTAJvuI5vtmmHla5yOJfsHHwD4cW153LtOnwIjrTpQO00-YAh89xgn5__7aoz4urn2cX9fyqsKKUfVHKxgrVWFVyAdxWitnK8KUUlSWzhrVEiJbafBWIlsmZFe1SgRCcqXLZGGB8gk6e-q6H5Qoamw-OptPr6FYmbnUwTr_PeHenb8NGz4jks_zcCfr83CCG-wFSr1cuWeg64yEMSTM5PlUpNc6aPqE2hpQitC9jKNGja3p-80O_upYLjt8u94L_t4k_ApNelZ8</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Xu, Chelsea</creator><creator>Smith, Edward R</creator><creator>Tiong, Mark K</creator><creator>Ruderman, Irene</creator><creator>Toussaint, Nigel D</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2651-1787</orcidid><orcidid>https://orcid.org/0000-0001-9348-4638</orcidid></search><sort><creationdate>202205</creationdate><title>Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials</title><author>Xu, Chelsea ; Smith, Edward R ; Tiong, Mark K ; Ruderman, Irene ; Toussaint, Nigel D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-56dc48dc8534e3c782c7a3b647c09d2f044f1c523e4f269c4fb8e443285bdae23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Clinical Research</topic><topic>Female</topic><topic>Humans</topic><topic>Magnesium</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Renal Dialysis</topic><topic>Renal Insufficiency, Chronic - drug therapy</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>Vascular Calcification - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xu, Chelsea</creatorcontrib><creatorcontrib>Smith, Edward R</creatorcontrib><creatorcontrib>Tiong, Mark K</creatorcontrib><creatorcontrib>Ruderman, Irene</creatorcontrib><creatorcontrib>Toussaint, Nigel D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xu, Chelsea</au><au>Smith, Edward R</au><au>Tiong, Mark K</au><au>Ruderman, Irene</au><au>Toussaint, Nigel D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials</atitle><jtitle>Journal of the American Society of Nephrology</jtitle><addtitle>J Am Soc Nephrol</addtitle><date>2022-05</date><risdate>2022</risdate><volume>33</volume><issue>5</issue><spage>1011</spage><epage>1032</epage><pages>1011-1032</pages><issn>1046-6673</issn><eissn>1533-3450</eissn><abstract>Vascular calcification is associated with cardiovascular morbidity and mortality in people with CKD. Evidence-based interventions that may attenuate its progression in CKD remain uncertain.
We conducted a systematic review of prospective clinical trials of interventions to attenuate vascular calcification in people with CKD, compared with placebo, another comparator, or standard of care. We included prospective clinical trials (randomized and nonrandomized) involving participants with stage 3-5D CKD or kidney transplant recipients; the outcome was vascular calcification measured using radiologic methods. Quality of evidence was determined by the Cochrane risk of bias assessment tool and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
There were 77 trials (63 randomized) involving 6898 participants eligible for inclusion (median sample size, 50; median duration, 12 months); 58 involved participants on dialysis, 15 involved individuals with nondialysis CKD, and 4 involved kidney transplant recipients. Risk of bias was moderate over all. Trials involving magnesium and sodium thiosulfate consistently showed attenuation of vascular calcification. Trials involving intestinal phosphate binders, alterations in dialysate calcium concentration, vitamin K therapy, calcimimetics, and antiresorptive agents had conflicting or inconclusive outcomes. Trials involving vitamin D therapy and HMG-CoA reductase inhibitors did not demonstrate attenuation of vascular calcification. Mixed results were reported for single studies of exercise, vitamin E-coated or high-flux hemodialysis membranes, interdialytic sodium bicarbonate, SNF472, spironolactone, sotatercept, nicotinamide, and oral activated charcoal.
Currently, there are insufficient or conflicting data regarding interventions evaluated in clinical trials for mitigation of vascular calcification in people with CKD. Therapy involving magnesium or sodium thiosulfate appears most promising, but evaluable studies were small and of short duration.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>35232774</pmid><doi>10.1681/asn.2021101327</doi><tpages>22</tpages><orcidid>https://orcid.org/0000-0002-2651-1787</orcidid><orcidid>https://orcid.org/0000-0001-9348-4638</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Clinical Research Female Humans Magnesium Male Prospective Studies Renal Dialysis Renal Insufficiency, Chronic - drug therapy Renal Insufficiency, Chronic - therapy Vascular Calcification - etiology |
title | Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials |
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