Key result
Treatment-induced reductions in left ventricular mass over 12 months or more were associated with a 28% lower risk of all-cause mortality (RR 0.72) in patients with chronic kidney disease.
Why the study?
Previous reviews showed no clear association between intervention-induced left ventricular mass change and all-cause or cardiovascular mortality in chronic kidney disease.
Do interventions that reduce left ventricular mass reduce all-cause mortality in patients with chronic kidney disease?
Meta-Analysis (n=5,190)
Do interventions that reduce left ventricular mass reduce all-cause mortality in patients with chronic kidney disease?
Intervention-induced left ventricular mass regression is associated with reduced all-cause mortality in patients with chronic kidney disease, supporting its use as a surrogate marker for mortality benefit.
Supports LVM regression as a surrogate for mortality benefit in CKD; reinforces its prognostic value in guiding interventions.
BACKGROUND: Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. METHODS: The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. RESULTS: The meta-analysis included 42 trials with duration ≥12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 12 of other types of interventions. All-cause mortality was reported in 121/2584 (4.86%) subjects in intervention groups and 168/2606 (6.45%) subjects in control groups. The pooled RR estimate of the 27 trials ≥12 months with ≥1 event in ≥1 group was 0.72 (95% CI 0.57 to 0.90, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥6 months (34 trials), ≥9 months (29 trials), and >12 months (10 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.67, 95% CI 0.39 to 1.16. CONCLUSIONS: These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.
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Maki et al. (2022) conducted a meta-analysis in Chronic kidney disease (n=5,190). Treatment-induced left ventricular mass regression vs. Control condition was evaluated on All-cause mortality (RR 0.72, 95% CI 0.57 to 0.90, p=0.005). Treatment-induced reductions in left ventricular mass over 12 months or more were associated with a 28% lower risk of all-cause mortality (RR 0.72) in patients with chronic kidney disease.
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