Comparison of newer and established sterols versus controls, and comparison of newer vitamin D versus established one on number of death.

<p>Comparison of newer and established sterols versus controls, and comparison of newer vitamin D versus established one on number of death.</p

Impact of Vitamin D on Chronic Kidney Diseases in Non-Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

<div><p>Background and Objectives</p><p>Recent studies have supported a role for both newer and more established vitamin D compounds in improving proteinuria, although systematic evaluation is lacking. Furthermore, concerns remain regarding the influence of vitamin D on the progression of renal function. We analyzed the efficacy and safety of vitamin D in non-dialysis patients and compared the use of newer versus established vitamin D compounds by performing a meta-analysis of randomized controlled trials.</p><p>Design</p><p>A literature search of PubMed (1975 to September, 2012), EMBASE.com (1966 to September, 2012) and Ovid EBM Reviews (through September, 2012) was conducted.</p><p>Results</p><p>Eighteen studies were eligible for final inclusion; of these, six explored the effects of vitamin D on proteinuria, twelve studied the effects of supplementation on renal function, and fifteen discussed the incidence of hypercalcemia. Compared to the placebo or no interference, both the newer and established vitamin D sterols reduced proteinuria to a similar extent (RR, 2.00; 95% CI, 1.42 to 2.81). No decrease in the glomerular filter rate was observed (SMD, −0.10; 95%CI, −0.24 to 0.03), and the risk for dialysis initiation was 1.48 (95% CI, 0.54 to 4.03) with vitamin D treatment. Additionally, there was an increased risk of hypercalcemia for patients treated with either newer or established vitamin D compounds as compared with the controls (RR, 4.78; 95% CI, 2.20 to 10.37). The head-to-head studies showed no differences in the effects of either newer or established compounds on proteinuria or the risk of hypercalcemia. No serious adverse events were associated with the administration of vitamin D.</p><p>Conclusions</p><p>Vitamin D therapy appears to decrease proteinuria and have no negative influence on renal function in non-dialysis patients. But the occurrence of hypercalcemia should be evaluated when vitamin D is provided. No superiority for newer versus established vitamin D analogue is found.</p></div

Study flow diagram for the trials selection and exclusion.

<p>Study flow diagram for the trials selection and exclusion.</p

Comparison of newer and established vitamin D sterols versus controls respectively on the number of participates with reduction in proteinuria.

<p>Comparison of newer and established vitamin D sterols versus controls respectively on the number of participates with reduction in proteinuria.</p

Comparison of newer vitamin D sterol and established one versus controls, and comparison of newer vitamin D versus established one on the risk of hypercalcemia.

<p>Comparison of newer vitamin D sterol and established one versus controls, and comparison of newer vitamin D versus established one on the risk of hypercalcemia.</p

Characteristics of the randomized controlled clinical trials involved in this analysis.

<p>GFR, glomerular filtration rate; CCr, rate of creatinine clearance; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; RASi, rennin-angiotensin system inhibitor ; DM, diabetes mellitus; PKD, polycystic kidney disease; HBP, high blood pressure (hypertension).</p

Adverse events mentioned in the trials.

<p>Adverse events mentioned in the trials.</p

Comparison of newer and established compounds versus controls, and comparison of newer vitamin D versus established one on number of patients with premature withdrawal.

<p>Comparison of newer and established compounds versus controls, and comparison of newer vitamin D versus established one on number of patients with premature withdrawal.</p

Subgroup analyses to explore the reasons for heterogeneity in the trials that discussed the number of premature withdrawals.

<p>Subgroup analyses to explore the reasons for heterogeneity in the trials that discussed the number of premature withdrawals.</p

Effect of newer and established vitamin D compound on renal function versus controls respectively.

<p>Effect of newer and established vitamin D compound on renal function versus controls respectively.</p