Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Interventions and Comparators
2.3. Systematic Review Protocol
2.4. Data Sources and Search Strategy
2.5. Study Selection and Data Extraction
2.6. Risk of Bias
2.7. Data Analysis: Fragility Index Calculation
3. Results
3.1. Characteristics of Trials
3.2. Fragility Index
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Trial Characteristics | Studies (n) |
---|---|
Sample size, median (min–max) | 1693.5 (73–17,276) |
Follow-up (months), median (min–max) | 38 (24–58) |
ACEi vs. placebo | 8 |
ARB vs. placebo | 4 |
ACEi vs. active control | 5 |
ARB vs. active control | 6 |
RAASi vs. active control or ACE-I vs. no treatment | 1 |
Primary endpoint | |
p-value | |
>0.05 | 10 |
0.01–0.05 | 8 |
0.001–0.01 | 2 |
<0.001 | 4 |
Secondary endpoints | |
All-cause mortality | |
Reported p-value < 0.05 | 3 |
Total | 8 |
Cardiovascular mortality | |
Reported p-value < 0.05 | 2 |
Total | 5 |
All-cause hospitalization | |
Reported p-value < 0.05 | 2 |
Total | 2 |
CV hospitalization | |
Reported p-value < 0.05 | 2 |
Total | 2 |
Major CV events | |
Reported p-value < 0.05 | 4 |
Total | 6 |
Major cerebrovascular events | |
Reported p-value < 0.05 | 2 |
Total | 5 |
New or worsening nephropathy | |
Reported p-value < 0.05 | 1 |
Total | 2 |
Allocation concealment | |
None or unknown | 21 |
Yes | 1 |
Intention-to-treat analysis | |
Yes | 12 |
No or unclear | 10 |
Blinding to treatment | |
Yes | 14 |
No or unclear | 8 |
Journals | |
Nephrological | 5 |
General medical | 17 |
Type of population | |
CKD | 10 |
CKD and no CKD | 12 |
Outcome | FI Median (Range) |
---|---|
Primary | |
CKD | 5.5 (1–117) |
no CKD | 22 (1–80) |
Secondary | |
CKD | 5.5 (1–33) |
No CKD | 13.5 (1–55) |
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Capuano, I.; Buonanno, P.; Riccio, E.; Bianco, A.; Pisani, A. Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis. J. Clin. Med. 2022, 11, 6184. https://doi.org/10.3390/jcm11206184
Capuano I, Buonanno P, Riccio E, Bianco A, Pisani A. Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis. Journal of Clinical Medicine. 2022; 11(20):6184. https://doi.org/10.3390/jcm11206184
Chicago/Turabian StyleCapuano, Ivana, Pasquale Buonanno, Eleonora Riccio, Antonio Bianco, and Antonio Pisani. 2022. "Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis" Journal of Clinical Medicine 11, no. 20: 6184. https://doi.org/10.3390/jcm11206184