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Chinese Medical Journal Nov 2018Type 2 diabetes (T2DM) patients are susceptible to Helicobacter pylori (HP), and it has been reported that the occurrence of proteinuria is associated with HP infection... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Type 2 diabetes (T2DM) patients are susceptible to Helicobacter pylori (HP), and it has been reported that the occurrence of proteinuria is associated with HP infection in T2DM patients; however, this view remains controversial. This meta-analysis aimed to explore the association between HP infection and the occurrence of proteinuria in T2DM patients. In addition, we hope to provide some recommendations to readers in clinical or related fields.
METHODS
Our meta-analysis was conducted with the methodology of the Cochrane Collaboration. Search strategies were formulated by relevant professionals. Case-control studies that compared the occurrence of proteinuria in T2DM patients with and without HP infection were involved in our meta-analysis. Relevant English or Chinese studies were searched on online databases before 2018, including PubMed, the Cochrane library, Medline, Google Scholar, the China National Infrastructure, and Wanfang database. The search strategies were "diabetic proteinuria, diabetic microalbuminuria, diabetic albuminuria, diabetic kidney disease, diabetic renal dysfunction, diabetic renal disease, diabetic nephropathy, diabetic complications, and diabetic mellitus, combined with HP." The quality of these involved articles was separately assessed by two investigators using the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and associated 95% confidence intervals (CIs) were extracted and pooled using fixed-effects models.
RESULTS
Seven studies involving 1029 participants were included. The quality of these seven articles was all above five stars as assessed by NOS, and there was no significant publication bias in our meta-analysis. We found that T2DM patients with HP infection had a 2.00 times higher risk of the occurrence of proteinuria than patients without HP infection (OR: 2.00, 95% CI: 1.48-2.69).
CONCLUSIONS
Our analysis showed that HP infection was associated with the occurrence of proteinuria in T2DM patients. HP radical surgery might be a therapeutic option for protecting kidney function in patients with T2DM.
Topics: Confidence Intervals; Diabetes Mellitus, Type 2; Helicobacter Infections; Humans; Kidney; Proteinuria
PubMed: 30425200
DOI: 10.4103/0366-6999.245269 -
Diabetes, Obesity & Metabolism Mar 2019To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy,... (Meta-Analysis)
Meta-Analysis
Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta-analysis.
AIMS
To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM).
MATERIALS AND METHODS
Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta-analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350).
RESULTS
Thirty-two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001).
CONCLUSION
The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to ESRD.
Topics: Asia; Asian People; Black People; Caribbean Region; Diabetic Nephropathies; Disease Progression; Ethnicity; Female; Humans; Male; Prevalence; White People
PubMed: 30407709
DOI: 10.1111/dom.13569 -
Diabetes Research and Clinical Practice Dec 2018The effect of intensive glycaemic control, blood pressure control and lipid levels control alone or as part of a multifactorial intervention has not been fully... (Meta-Analysis)
Meta-Analysis
Effects of intensive interventions compared to standard care in people with type 2 diabetes and microalbuminuria on risk factors control and cardiovascular outcomes: A systematic review and meta-analysis of randomised controlled trials.
AIMS
The effect of intensive glycaemic control, blood pressure control and lipid levels control alone or as part of a multifactorial intervention has not been fully evaluated. We aimed to estimate the effects of more intensive interventions, compared with standard care, on risk factor control and cardiovascular outcomes in people with type 2 diabetes and microalbuminuria.
METHODS
We searched MEDLINE, Embase and the Cochrane library without language restrictions from inception to August 10, 2018. We included randomised controlled trials that evaluated intensive interventions in adults with type 2 diabetes and microalbuminuria. The review was registered on PROSPERO (registration number 42017055208). We used random effects meta-analysis to calculate overall pooled effect estimates across studies.
RESULTS
A total of seven (n = 1210) randomised controlled trials were included, four studies (n = 758) reported HbA1c, six studies (n = 950) reported blood pressure measurements, and three studies (n = 896) examined non-fatal MI, non-fatal stroke, cardiovascular mortality, and all-cause mortality. Intensive interventions indicated statistically significant reductions in both systolic and diastolic blood pressure, and a nonsignificant trend for reduction in HbA1c, total cholesterol, LDL, triglycerides and urinary albumin excretion rate. There was no evidence to suggest that compared with standard care, intensive interventions reduced the risk of non-fatal MI [risk ratio (RR) 0·50; 95% CI 0·20, 1·22; P = 0·127], non-fatal stroke (RR 0·44; 95% CI 0·10, 1·91; P = 0·275), CV mortality (RR 0·95; 95% CI 0·48, 1·86; P = 0·874) or all-cause mortality (RR 0·80; 95% CI 0·51, 1·25; P = 0·324).
CONCLUSIONS
Apart from blood pressure outcomes, there was no evidence that intensive interventions improve or worsen HbA1c, total cholesterol, LDL, triglycerides, urinary albumin excretion rate, risk of cardiovascular or mortality outcomes in people with type 2 diabetes and microalbuminuria. Results of this review are mainly influenced by one small trial, hence uncertainty surrounding the effect of intensive interventions in people with type 2 diabetes and microalbuminuria still exists. Large studies are urgently required in this high risk cardiovascular group of patients.
Topics: Albuminuria; Blood Glucose; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 30312714
DOI: 10.1016/j.diabres.2018.10.002 -
Hippokratia 2018Matrix metalloproteinases (MMPs) are a family of zinc-dependent proteinases involved in remodeling the extracellular matrix. Tissue inhibitors of metalloproteinases... (Review)
Review
INTRODUCTION
Matrix metalloproteinases (MMPs) are a family of zinc-dependent proteinases involved in remodeling the extracellular matrix. Tissue inhibitors of metalloproteinases (TIMPs) are a family of four proteins that act to limit the degradative actions of MMPs. Chronic kidney disease (CKD) and acute kidney injury (AKI) are public health problems worldwide, the prevalence of which has been increasing. Recent concept considers MMPs and TIMPs as critical factors before the onset of microalbuminuria, as well as accelerating factors associated with the breakdown of the glomerular basement membrane, renal scarring, and fibrosis during the progression of kidney diseases. Here we reviewed studies of the expression of MMPs and TIMPs in humans, using as clinical samples serum, plasma, and urine, with a focus on their potential role as molecular markers in CKD and AKI, as non-invasive markers.
MATERIAL AND METHODS
We used as data sources, studies at Medline database using combinations of the following keywords: CKD, AKI, MMP, TIMP, serum, plasma, and urine.
RESULTS
Evidence suggests that MMPs/TIMPs could be potential targets for therapeutic intervention in kidney diseases; future studies should attempt to improve the diagnostic or prognostic power of these families.
DISCUSSION
Considering published guides, such as biospecimen reporting for improved study quality (BRISQ), strengthening the reporting of observational studies in epidemiology (STROBE), an updated list of essential items for reporting diagnostic accuracy studies (STARD), transparent reporting of a multivariate prediction model for individual prognosis or diagnosis (TRIPOD), and on the studies reviewed here, we have adapted published recommendations and proposed other news in order to enhance the transparency and quality of MMPs/TIMPs research in CKD and AKI. This review reinforces the complexities of MMPs/TIMPs in the pathobiology of the kidney and the need for well-designed and transparent biomedical studies. HIPPOKRATIA 2018, 22(3): 99-104.
PubMed: 31641330
DOI: No ID Found -
Kidney & Blood Pressure Research 2018Whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) could benefit patients with diabetes and albuminuria remains... (Meta-Analysis)
Meta-Analysis Review
Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis.
BACKGROUND/AIMS
Whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) could benefit patients with diabetes and albuminuria remains controversial. A systematic review and meta-analysis were conducted to answer this question by comparing ACE inhibitors or ARB with placebo among these patients.
METHODS
In this meta-analysis, electronic data sources (Medline, the Cochrane Collaboration, and EMBASE) were searched. Randomized controlled trials (RCTs) comparing ACE inhibitors or ARB with placebo in subjects with diabetes and albuminuria (defined as urinary albumin-to-creatinine ratio, UACR≥30mg/g Cr) were included. Outcomes parameters were all-cause mortality, end stage renal disease (ESRD), doubling of serum creatinine levels, and cardiovascular events (CV).
RESULTS
Twenty-six RCTs (including 20 for ACE inhibitors and 6 for ARB) were included, comprising 10378 participants with diabetes and albuminuria. Compared to placebo, treatment with ACE inhibitors or ARBs did not reduce all-cause mortality or CV. For renal outcomes, ARBs significantly reduced the risk of ESRD by 23% (odds ratio 0.77, 95%CI 0.65-0.92), while ACE inhibitors were not associated with a decreased risk of ESRD (0.69, 0.43-1.10). Both ACE inhibitors and ARBs reduced the risk of doubling of the serum creatinine level (0.60, 0.39-0.91 for ACE inhibitors; 0.75, 0.64-0.88 for ARBs), and subgroup analyses for patients with macroalbuminuria or microalbuminuria showed similar results.
CONCLUSION
In patients with diabetes and albuminuria, ARBs reduced risks of ESRD and doubling of the serum creatinine level. ACE inhibitors and ARBs failed to reduce all-cause mortality and CV. Based on the renoprotective effects, ARBs may be preferred for diabetic patients with albuminuria.
Topics: Albuminuria; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Diseases; Creatinine; Diabetes Mellitus; Humans; Kidney Failure, Chronic; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 29794446
DOI: 10.1159/000489913 -
European Journal of Gastroenterology &... Sep 2018The relationship between nonalcoholic fatty liver disease (NAFLD) and albuminuria has been shown in many epidemiologic studies, although the results were inconsistent.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/OBJECTIVES
The relationship between nonalcoholic fatty liver disease (NAFLD) and albuminuria has been shown in many epidemiologic studies, although the results were inconsistent. This meta-analysis was conducted to summarize all available data and to estimate the risk of albuminuria among patients with NAFLD.
METHODS
Comprehensive literature review was conducted utilizing Medline and Embase database through January 2018 to identify studies that compared the risk of albuminuria among patients with NAFLD versus those without NAFLD. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird.
RESULTS
Nineteen studies (17 cross-sectional studies and two cohort studies) with 24 804 participants fulfilled the eligibility criteria and were included in this meta-analysis. The risk of albuminuria among patients with NAFLD was significantly higher than those without NAFLD with the pooled odds ratio (OR) of 1.67 [95% confidence interval (CI): 1.32-2.11]. Subgroup analysis demonstrated the significantly increased risk of albuminuria among patients with NAFLD without diabetes with pooled OR of 2.25 (95% CI: 1.65-3.06). However, we found no significant association between albuminuria and NAFLD among diabetic patients [pooled OR 1.28 (95% CI: 0.94-1.75)].
CONCLUSION
A significantly increased risk of albuminuria among patients with NAFLD was observed in this meta-analysis. Physicians should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria especially in patients with NAFLD.
Topics: Adult; Aged; Albuminuria; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Humans; Male; Middle Aged; Non-alcoholic Fatty Liver Disease; Odds Ratio; Risk Assessment; Risk Factors
PubMed: 29787418
DOI: 10.1097/MEG.0000000000001169 -
International Urology and Nephrology May 2018The aim of this study was to assess the effects of smoking on albuminuria risk in adults with type 2 diabetes mellitus (T2DM). (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this study was to assess the effects of smoking on albuminuria risk in adults with type 2 diabetes mellitus (T2DM).
METHODS
A literature search was conducted using MEDLINE, EMBASE, and China National Knowledge Infrastructure from the established date to October 2017. Summary relative risks (SRR) and 95% confidence intervals (CI) were computed utilizing a random effect inverse variance method.
RESULTS
This meta-analysis included a total of 19 relevant observational studies (four prospective cohort, seven case-control, and eight cross-sectional studies), reporting 105,031 participants and 23,366 albuminuria events. Compared with never-smokers with T2DM, the SRRs of albuminuria were 1.43 (95% CIs 1.27-1.61) for ever-smokers, 2.61 (95% CIs 1.86-3.64) for current smokers, and 1.86 (95% CIs 1.37-2.52) for former smokers. Considerable heterogeneity was observed among these studies, and study design was a significant modifier for this association. There were significantly elevated risk associations for microalbuminuria (SRRs = 1.24, 95% CIs 1.05-1.46) and for macroalbuminuria (SRRs = 1.65, 95% CIs 1.03-2.66), respectively.
CONCLUSIONS
Our systematic review and meta-analysis indicates that cigarette smoking might be a potential factor for the development of albuminuria in adults with T2DM. Future studies are required to investigate the association between smoking cessation and intensity and incident albuminuria in adults with T2DM.
Topics: Albuminuria; Cigarette Smoking; Diabetes Mellitus, Type 2; Humans; Observational Studies as Topic; Risk Factors
PubMed: 29476432
DOI: 10.1007/s11255-018-1825-x -
Diabetes & Vascular Disease Research Sep 2017Aliskiren was shown to increase adverse events in patients with diabetes and concomitant renin-angiotensin blockade. We aim to investigate the efficacy and safety of... (Meta-Analysis)
Meta-Analysis Review
Effects of aliskiren on mortality, cardiovascular outcomes and adverse events in patients with diabetes and cardiovascular disease or risk: A systematic review and meta-analysis of 13,395 patients.
BACKGROUND
Aliskiren was shown to increase adverse events in patients with diabetes and concomitant renin-angiotensin blockade. We aim to investigate the efficacy and safety of aliskiren in patients with diabetes and increased cardiovascular risk or established cardiovascular disease.
METHODS
MEDLINE and Embase were searched for prospective studies comparing addition of aliskiren to standard medical therapy in patients with diabetes and cardiovascular disease, or ⩾1 additional cardiovascular risk factor (hypertension, abnormal lipid profile, microalbuminuria/proteinuria, chronic kidney disease). Relative risk for efficacy (all-cause mortality, combined cardiovascular mortality and hospitalisation) and safety (hyperkalaemia, hypotension, renal impairment) outcomes was calculated.
RESULTS
Of 2151 studies identified in the search, seven studies enrolling 13,395 patients were included. Aliskiren had no effect on all-cause mortality (relative risk: 1.05, 95% confidence interval: 0.90 to 1.24, p = 0.53), or combined cardiovascular mortality or heart failure hospitalisation (relative risk: 1.07, 95% confidence interval: 0.81 to 1.40, p = 0.64). Patients receiving aliskiren had a greater risk of developing hyperkalaemia (relative risk: 1.32, 95% confidence interval: 1.14 to 1.53, p = 0.0003) and renal impairment (relative risk: 1.15, 95% confidence interval: 1.02 to 1.30, p = 0.03), but not hypotension.
CONCLUSION
Patients with diabetes and cardiovascular disease or cardiovascular risk do not benefit from the addition of aliskiren to standard medical therapy. Detrimental safety profile in pooled analysis supports current warnings.
Topics: Amides; Cardiovascular Agents; Cardiovascular Diseases; Chi-Square Distribution; Diabetes Mellitus; Fumarates; Humans; Odds Ratio; Renin-Angiotensin System; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 28844155
DOI: 10.1177/1479164117715854 -
BMJ Open Jul 2017The aim of this systematic review is to explore the association of South Asian (SA) ethnicity on comorbidities, microvascular and macrovascular complications and... (Review)
Review
OBJECTIVE
The aim of this systematic review is to explore the association of South Asian (SA) ethnicity on comorbidities, microvascular and macrovascular complications and mortality compared with other ethnic groups in people with type 1 diabetes mellitus (T1DM).
DESIGN
Systematic review.
METHOD
A systematic literature search strategy was designed and carried out using Medline and Embase for full-text and abstract studies published in English from 1946 to February 2016. The initial search identified 4722 papers. We assessed 305 full-text articles in detail for potential inclusion. Ten papers met the inclusion criteria for review and an additional one paper was included from our secondary search strategy using the bibliography of included studies. In total, 11 studies were included.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies were included if they were published in English, involved SA participants with T1DM and compared them with non-SA participants and assessed one of the outcomes of comorbidities, microvascular complications, macrovascular complications and mortality.
RESULTS
SA with T1DM have higher mortality compared with white Europeans (WE), mainly contributed to by excess cardiovascular disease. SA have significantly higher glycated haemoglobin (HbA1c), lower high-density lipoprotein (HDL) and lower rates of neuropathy compared with WE. There were no differences in rates of retinopathy and nephropathy. Compared with Africans, SA had lower levels of microalbuminuria, HbA1c and systolic blood pressure and higher HDL levels. There were no significant differences in the remaining outcomes: cardiovascular disease, retinopathy, neuropathy and body mass index. Furthermore, SA have higher HbA1c levels than Malay and Chinese and higher waistâ€"hip ratio and lower HDL levels compared with Chinese only.
CONCLUSION
Our analysis highlights ethnic disparity in macrovascular outcomes that is so evident for type 2 diabetes mellitus may also be present for SA patients with T1DM. We highlight the need for a large, prospective, cohort study exploring the effect of ethnicity in a uniform healthcare setting.
Topics: Albuminuria; Asia, Southeastern; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus, Type 1; Ethnicity; Glycated Hemoglobin; Humans; Lipoproteins, HDL
PubMed: 28710207
DOI: 10.1136/bmjopen-2016-015005 -
The Cochrane Database of Systematic... Jul 2017Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta-globin) genes. SCD... (Review)
Review
BACKGROUND
Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta-globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Kidney disease is a frequent and potentially severe complication in people with SCD.Chronic kidney disease is defined as abnormalities of kidney structure or function, present for more than three months. Sickle cell nephropathy refers to the spectrum of kidney complications in SCD.Glomerular damage is a cause of microalbuminuria and can develop at an early age in children with SCD, and increases in prevalence in adulthood. In people with sickle cell nephropathy, outcomes are poor as a result of the progression to proteinuria and chronic kidney insufficiency. Up to 12% of people who develop sickle cell nephropathy will develop end-stage renal disease.
OBJECTIVES
To assess the effectiveness of any intervention in preventing or reducing kidney complications or chronic kidney disease in people with SCD (including red blood cell transfusions, hydroxyurea and angiotensin-converting enzyme inhibitor (ACEI)), either alone or in combination with each other.
SEARCH METHODS
We searched for relevant trials in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 05 April 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 13 April 2017.
SELECTION CRITERIA
Randomised controlled trials comparing interventions to prevent or reduce kidney complications or chronic kidney disease in people with SCD. There were no restrictions by outcomes examined, language or publication status.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias.
MAIN RESULTS
We included two trials with 215 participants. One trial was published in 2011 and included 193 children aged 9 months to 18 months, and compared treatment with hydroxyurea to placebo. The second trial was published in 1998 and included 22 adults with normal blood pressure and microalbuminuria and compared ACEI to placebo.We rated the quality of evidence as low to very low across different outcomes according to GRADE methodology. This was due to trials having: a high or unclear risk of bias including attrition and detection bias; indirectness (the available evidence was for children aged 9 months to 18 months in one trial and a small and select adult sample size in a second trial); and imprecise outcome effect estimates of significant benefit or harm. Hydroxyurea versus placebo We are very uncertain if hydroxyurea reduces or prevents progression of kidney disease (assessed by change in glomerular filtration rate), or reduces hyperfiltration in children aged 9 to 18 months, mean difference (MD) 0.58 (95% confidence interval (CI) -14.60 to 15.76 (mL/min per 1.73 m²)) (one study; 142 participants; very low-quality evidence).In children aged 9 to 18 months, hydroxyurea may improve the ability to concentrate urine, MD 42.23 (95% CI 12.14 to 72.32 (mOsm/kg)) (one study; 178 participants; low-quality evidence).Hydroxyurea may make little or no difference to SCD-related serious adverse events including: incidence of acute chest syndrome, risk ratio (RR) 0.39 (99% CI 0.13 to 1.16); painful crisis, RR 0.68 (99% CI 0.45 to 1.02); and hospitalisations, RR 0.83 (99% CI 0.68 to 1.01) (one study, 193 participants; low-quality evidence).No deaths occurred in the trial. Quality of life was not reported. ACEI versus placeboWe are very uncertain if ACEI reduces proteinuria in adults with SCD who have normal blood pressure and microalbuminuria, MD -49.00 (95% CI -124.10 to 26.10 (mg per day)) (one study; 22 participants; very low-quality evidence). We are very uncertain if ACEI reduce or prevent kidney disease as measured by creatinine clearance. The authors state that creatinine clearance remained constant over six months in both groups, but no comparative data were provided (very low-quality evidence).All-cause mortality, serious adverse events and quality of life were not reported.
AUTHORS' CONCLUSIONS
In young children aged 9 months to 18 months, we are very uncertain if hydroxyurea improves glomerular filtration rate or reduces hyperfiltration, but it may improve young children's ability to concentrate urine and may make little or no difference on the incidence of acute chest syndrome, painful crises and hospitalisations.We are very uncertain if giving ACEI to adults with normal blood pressure and microalbuminuria has any effect on preventing or reducing kidney complications.This review identified no trials that looked at red cell transfusions nor any combinations of interventions to prevent or reduce kidney complications.Due to lack of evidence this review cannot comment on the management of either children aged over 18 months or adults with any known genotype of SCD.We have identified a lack of adequately-designed and powered studies, and no ongoing trials which address this critical question. Trials of hydroxyurea, ACEI or red blood cell transfusion in older children and adults are urgently needed to determine any effect on prevention or reduction kidney complications in people with SCD.
Topics: Adult; Albuminuria; Anemia, Sickle Cell; Angiotensin-Converting Enzyme Inhibitors; Antisickling Agents; Creatinine; Glomerular Filtration Rate; Hospitalization; Humans; Hydroxyurea; Infant; Kidney Failure, Chronic; Placebos; Randomized Controlled Trials as Topic
PubMed: 28672087
DOI: 10.1002/14651858.CD012380.pub2