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Lower circulating soluble Klotho level is associated with increased risk of all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis.
International Urology and Nephrology ( IF 2 ) Pub Date : 2020-05-27 , DOI: 10.1007/s11255-020-02510-1
Nipith Charoenngam 1 , Ben Ponvilawan 2 , Patompong Ungprasert 3
Affiliation  

Purpose

This study aimed to investigate the association between circulating soluble Klotho level and risk of all-cause mortality in chronic kidney disease (CKD) patients using systematic review and meta-analysis technique.

Methods

Potentially eligible studies were identified from Medline and EMBASE databases from inception to March 2020 using a search strategy that consisted of terms for “Klotho” and “Mortality”. Eligible study must be a cohort study that consists of one cohort of CKD patients with higher circulating soluble Klotho level and another cohort of CKD patients with lower circulating soluble Klotho level. The study must also report relative risk (RR), incidence rate ratio, hazard risk ratio or standardized incidence ratio with 95% confidence intervals (95% CIs) comparing all-cause mortality between CKD patients with lower circulating soluble Klotho level versus CKD patients with higher circulating soluble Klotho level. If the study divides patients (per circulating soluble Klotho level) into more than two groups, a comparison between the highest and the lowest group would be extracted. Point estimates with standard errors were retrieved from each study and were combined together using the generic inverse variance method.

Results

A total of 2964 articles were retrieved. After two rounds of an independent review by two investigators, six prospective cohort studies met the eligibility criteria and were included into the meta-analysis. CKD patients with lower circulating soluble Klotho level had a significantly increased risk of all-cause mortality with the pooled risk ratio of 1.88 (95% CI 1.29–2.74; I2 0%). The funnel plot was fairly symmetric and did not reveal any suggestive evidence of publication bias.

Conclusion

The current study found a significant association between lower circulating soluble Klotho level and increased risk of all-cause mortality in CKD patients. However, this meta-analysis carries some limitations, including relatively small sample size, lack of adjustment for potential confounders and between-study heterogeneity in baseline characteristics of the patients and cut-off values used to categorize patients into higher and lower circulating serum Klotho level group.



中文翻译:

较低的循环可溶性Klotho水平与慢性肾脏病患者全因死亡的风险增加相关:系统评价和荟萃分析。

目的

本研究旨在通过系统评价和荟萃分析技术研究慢性肾脏病(CKD)患者的循环可溶性Klotho水平与全因死亡率风险之间的关系。

方法

从开始到2020年3月,从Medline和EMBASE数据库中识别出了潜在合格的研究,使用的搜索策略由“ Klotho”和“ Mortality”组成。符合条件的研究必须是一项队列研究,包括一个具有较高循环可溶性Klotho水平的CKD患者队列和另一个具有较低可循环可溶性Klotho水平的CKD患者队列。该研究还必须报告相对风险(RR),发生率比,危险风险比或标准化发生率以及95%置信区间(95%CI),比较循环可溶Klotho水平较低的CKD患者与CKD较低的CKD患者之间的全因死亡率循环可溶性Klotho含量较高。如果研究将患者(按循环可溶性Klotho水平)分为两组以上,将提取最高和最低组之间的比较。从每个研究中检索带有标准误差的点估计,并使用通用逆方差方法将其合并在一起。

结果

共检索到2964条文章。在两名研究者进行了两轮独立审查后,六项前瞻性队列研究符合入选标准,并纳入荟萃分析。循环可溶性Klotho水平较低的CKD患者的全因死亡率风险显着增加,合并风险比为1.88(95%CI 1.29–2.74;I 2 0%)。漏斗图是相当对称的,没有发现任何暗示出版偏见的证据。

结论

目前的研究发现,CKD患者较低的循环可溶性Klotho水平与全因死亡风险增加之间存在显着关联。但是,这种荟萃分析存在一些局限性,包括相对较小的样本量,缺乏对潜在混杂因素的调整以及患者基线特征的研究间异质性以及用于将患者分为较高和较低循环血清Klotho水平的临界值组。

更新日期:2020-05-27
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