Comparative Efficacy and Safety of Antihypertensive Strategies in Diabetic Kidney Disease: Protocol for an Update of a Systematic Review and Component Network Meta-Analysis.

内容摘要

Chronic kidney disease (CKD) is a significant global contributor to morbidity and mortality, with hypertension and diabetes mellitus remaining its primary causes. Effective antihypertensive treatment is a key modifiable strategy to improve outcomes in this population. However, the emergence of novel therapies, together with uncertainties over the synergistic effects and safety of combining antihypertensive drug classes, has left optimal blood pressure management in CKD and diabetes unclear. We present a study protocol for an updated systematic review and component network meta-analysis, which aims to answer which blood pressure therapies in adults with diabetes mellitus who have or are at risk of CKD are most efficacious in improving survival and reducing the risk of end-stage kidney disease. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and has been registered in the PROSPERO registry (with the identifier: CRD42021286617). Updating a previous review, database searches will be performed in Cochrane Renal Group's specialized register; Embase OVID SP; MEDLINE OVID SP and the Cochrane Central Register of Randomized Trials for randomized controlled trials that evaluate antihypertensive treatments in adults with both CKD and diabetes mellitus. We will include trials that evaluate one or more of the following treatments administered in any combination: (1) angiotensin-converting enzyme inhibitors; (2) angiotensin receptor blockers; (3) calcium channel inhibitors; (4) beta-blockers; (5) renin inhibitors; (6) alpha blockers; (7) diuretics; (8) endothelin inhibitors; (9) non-steroidal and steroidal mineralocorticoid receptor antagonists. The primary outcomes are all-cause mortality and progression to end-stage kidney disease. This updated systematic review and component network meta-analysis will incorporate advanced novel analytical techniques to produce the first clinically meaningful hierarchy of antihypertensive interventions according to efficacy and safety in patients with CKD and diabetes mellitus, carrying implications for future clinical practice guidelines.