Chronic kidney disease
Результаты исследований
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
Таблица доказательств
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
Эта таблица представляет собой итоговый анализ, представленный в руководстве (подкрепленный систематическим обзором), которое фокусируется на обозначенном выше важном клиническом вопросе.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and the intervention may be less effective or likely to be more harmful than the comparison for key outcomes.
Население: Pre-dialysis or dialysis adults with hyperphosphatemic CKD ᵃ
Вмешательство: Calcium-containing phosphate binders
Сравнение: Calcium-free phosphate binders
| Клинические исходы | Эффективность (рейтинг BMJ)? | Уровень доказательности (СТЕПЕНЬ)? |
|---|---|---|
Mortality | Favours comparison | Moderate |
Cardiovascular and cerebrovascular events | See note ᵇ | Low |
Рекомендации, изложенные в исходном руководстве The 2017 Kidney Disease Improving Global Outcomes (KDIGO) guideline on CKD-MBD makes the following recommendation: In adult patients with CKD (GFR category) G3a–G5D receiving phosphate-lowering treatment, we suggest restricting the dose of calcium-based phosphate binders (weak recommendation; moderate-quality evidence).
Примечание ᵃ Population as reported by the guideline. ᵇ The guideline reported results for this outcome narratively due to inconsistent results across studies. See guideline for more information.
Эта таблица с доказательными данными относится к следующему разделу (разделам):
Эта таблица представляет собой итоговый анализ, представленный в руководстве (подкрепленный систематическим обзором), которое фокусируется на обозначенном выше важном клиническом вопросе.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Население: People with CKD G3a-G5 or G5D
Вмешательство: Lower concentrations of serum phosphate or calcium
Сравнение: Higher concentrations of serum phosphate or calcium
| Клинические исходы | Эффективность (рейтинг BMJ)? | Уровень доказательности (СТЕПЕНЬ)? |
|---|---|---|
Serum phosphate | ||
Mortality | Favours intervention | Low |
Glomerular Filtration Rate (GFR) decline | See note ᵃ | Very Low |
Cardiovascular and cerebrovascular events | See note ᵇ | Very Low |
Serum calcium | ||
Mortality | Favours intervention | Low |
Cardiovascular and cerebrovascular events | Favours intervention | Low |
Las recomendaciones que figuran en la directriz fuente The 2017 Kidney Disease Improving Global Outcomes (KDIGO) guideline on CKD-MBD makes the following recommendations: In patients with CKD (GFR category) G3a–G5D, treatments of CKD-MBD should be based on serial assessments of phosphate, calcium, and parathyroid hormone (PTH) levels, considered together (not graded). In people with CKD G3a-G5D, we suggest lowering elevated phosphate levels toward the normal range (weak recommendation; low-quality evidence). In adult patients with CKD G3a–G5D, we suggest avoiding hypercalcaemia (weak recommendation; low-quality evidence). In patients with CKD G3a–G5D, it is reasonable to base the frequency of monitoring serum calcium, phosphate, and PTH on the presence and magnitude of abnormalities, and the rate of progression of CKD (not graded).ᶜ
Nota The guideline only identified evidence from observational studies to answer this clinical question. ᵃ Reported as inconclusive based on indirect evidence from 8 observational studies (N=3755). ᵇ Reported as inconclusive based on direct evidence from 7 observational studies (N=34231). ᶜ The guideline group also recommended reasonable monitoring intervals (not graded). See guideline for more information.
Esta tabla de evidencias está relacionada con la/s sección/es siguiente/s:
Respuestas clínicas Cochrane
Las Respuestas Clínicas de la Cochrane (CCA) proporcionan un punto de entrada legible, sencillo y con enfoque clínico a la investigación rigurosa de las revisiones sistemáticas de la Cochrane. Están diseñadas para ser procesables e informar sobre la toma de decisiones en el punto de atención médica y se han añadido a las secciones pertinentes del texto principal de las Best Practice.
- How does two-weekly administration of erythropoiesis-stimulating agents compare with weekly and monthly administration for people with anemia due to chronic kidney disease who are not on dialysis?
- How does recombinant human erythropoietin compare with placebo/no treatment in people with anemia of chronic kidney disease who do not require dialysis?
- How do newer continuous erythropoiesis receptor activators compare with older erythropoiesis-stimulating agents in people with anemia of chronic kidney disease?
- In adults with chronic kidney disease and secondary hyperparathyroidism, what are the benefits and harms of cinacalcet?
- How do biocompatible dialysis fluids compare with standard glucose dialysate for people receiving peritoneal dialysis?
- How does intravenous iron compare with oral iron therapy for adults and adolescents with chronic kidney disease?
- What are the effects of a low‐protein diet for non‐diabetic adults with chronic kidney disease?
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