Effect of multifactorial intensive treatment in patients with diabetic kidney disease: a meta-analysis with trial sequential analysis.

Abstract

This meta-analysis was performed to assess the efficacy and safety of multifactorial intensive treatment (MT) in patients with diabetic kidney disease (DKD). We systematically searched PubMed, Embase and Web of science from their inception to February 2023 to identify randomized control trials (RCTs) evaluating the effect and safety of MT in patients with DKD. The quality of included RCTs was assessed using the risk of bias tool. The outcomes were expressed as hazard ratios (HR), risk ratio (RR) or weight mean difference (WMD) with 95% confidence intervals (95% CI), with a meta-analysis of a fixed-effect or random-effect model. Five RCTs were included for data analysis. The pooled analysis showed that, MT was associated with significant reductions in all-cause mortality (HR=0.75, 95%CI: 0.60, 0.93; P=0.008) and cardiovascular event disease (CVD) rate (HR=0.55, 95%CI: 0.44, 0.68; P<0.001). MT significantly decreased the retinopathy progression (HR=0.79, 95%CI: 0.66, 0.95; P=0.011), progression of macroalbuminuria (HR=0.64, 95%CI: 0.43, 0.95; P=0.027) and progression of microalbuminuria (HR=0.69, 95%CI: 0.56, 0.86; P=0.001). In addition, MT was not associated with an increased risk of all adverse events (RR=1.00, 95%CI: 0.97, 1.03; P=0.830) and all severe adverse events (RR=0.92, 95%CI: 0.74, 1.15; P=0.478), and the statistical power was confirmed by trial sequential analysis. The present study suggested that MT had a remarkable benefit on the risk of all-cause mortality and CVD in patients with DKD. Our results were promising, but had certain limitations, which warrants additional large-scale RCTs to validate our findings. This article is protected by copyright. All rights reserved.