Next Article in Journal
Relationship between Pulmonary Regurgitation and Ventriculo–Arterial Interactions in Patients with Post-Early Repair of Tetralogy of Fallot: Insights from Wave-Intensity Analysis
Next Article in Special Issue
Prevalence and Severity of Lower Gastrointestinal Symptoms amongst Non-Dialysis Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis
Previous Article in Journal
Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?
Previous Article in Special Issue
Comorbid Depression and Diabetes Are Associated with Impaired Health-Related Quality of Life in Chronic Kidney Disease Patients
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis

1
Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
2
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
3
Institute for Biomedical Research and Innovation, National Research Council of Italy, 80125 Palermo, Italy
4
Interdepartmental Research Center for Arterial Hypertension and Associated Pathologies (CIRIAPA)-Hypertension Research Center, University of Naples “Federico II”, 80131 Naples, Italy
*
Author to whom correspondence should be addressed.
These authors have contributed equally to this work and share first authorship.
J. Clin. Med. 2022, 11(20), 6184; https://doi.org/10.3390/jcm11206184
Submission received: 15 September 2022 / Revised: 12 October 2022 / Accepted: 13 October 2022 / Published: 20 October 2022

Abstract

Inhibition of the renin-angiotensin-aldosterone system (RAAS) is broadly recommended in many nephrological guidelines to prevent chronic kidney disease (CKD) progression. This work aimed to analyze the robustness of randomized controlled trials (RCTs) investigating the renal and cardiovascular outcomes in CKD stages 3–5 patients treated with RAAS inhibitors (RAASi). We searched for RCTs in MEDLINE (PubMed), EMBASE databases, and the Cochrane register. Fragility indexes (FIs) for every primary and secondary outcome were calculated according to Walsh et al., who first described this novel metric, suggesting 8 as the cut-off to consider a study robust. Spearman coefficient was calculated to correlate FI to p value and sample size of statistically significant primary and secondary outcomes. Twenty-two studies met the inclusion criteria, including 80,455 patients. Sample size considerably varied among the studies (median: 1693.5, range: 73–17,276). The median follow-up was 38 months (range 24–58). The overall median of both primary and secondary outcomes was 0 (range 0–117 and range 0–55, respectively). The median of FI for primary and secondary outcomes with a p value lower than 0.05 was 6 (range: 1–117) and 7.5 (range: 1–55), respectively. The medians of the FI for primary outcomes with a p value lower than 0.05 in CKD and no CKD patients were 5.5 (range 1–117) and 22 (range 1–80), respectively. Only a few RCTs have been shown to be robust. Our analysis underlined the need for further research with appropriate sample sizes and study design to explore the real potentialities of RAASi in the progression of CKD.
Keywords: chronic kidney disease 1; renin-angiotensin-aldosterone system inhibitors; fragility index; randomized controlled trials; robustness chronic kidney disease 1; renin-angiotensin-aldosterone system inhibitors; fragility index; randomized controlled trials; robustness

Share and Cite

MDPI and ACS Style

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

AMA Style

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 Style

Capuano, 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

APA Style

Capuano, I., Buonanno, P., Riccio, E., Bianco, A., & Pisani, A. (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(20), 6184. https://doi.org/10.3390/jcm11206184

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop