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Risk of aortic aneurysm or dissection in autosomal dominant polycystic kidney disease : systematic review and meta-analysis
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Introdução: A Doença Renal Poliquística Autossómica Dominante (DRPAD) apresenta-se por diversas manifestações renais e extra-renais. Alguns estudos reportaram uma maior incidência de aneurismas e disseções da aorta (AA e AD, respetivamente) nestes doentes, no entanto, não existe nenhuma associação comprovada. O objetivo deste estudo foi realizar uma revisão sistemática e meta-análise de estudos observacionais que avaliassem o risco de AA/AD em doentes com DRPAD.
Métodos: As seguintes bases de dados: MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection e OpenGrey - foram pesquisadas desde os primeiros registos até Maio de 2021 com o intuito de obter estudos observacionais que reportavam estimativas de frequência de AA/AD em doentes com DRPAD em comparação a controlos. A triagem dos artigos e extração de dados foi realizada por 2 autores e os dados foram agrupados usando um modelo de efeitos aleatórios. O outcome primário era o Odds Ratio (OR) da existência de AA/AD em doentes com DRPAD quando comparado com controlos. Os outcomes secundários eram a probabilidade de ter AA em doentes com DRPAD comparando com controlos, probabilidade de ter AD em doentes com DRPAD comparando com controlos, diferenças entre subtipos de AA (diferentes localizações) e de AD (tipo A ou tipo B), diferenças de acordo com a idade, com o género (masculino ou feminino) e com diferentes designs dos estudos.
Resultados: Foram incluídos 7 estudos observacionais. Observou-se um risco aumentado de AA/DA em doentes com quando comparado com controlos (OR: 4.33; 95% IC 2.69; 6.97, p < 0.001); maior risco de AA (OR: 4.18; 95% CI 2.36;7.40, p <0.001) e maior risco de AD (OR 9.08; 95% CI 3.11;26.55, p<0.001).
Conclusões: A DRPAD foi associada a um risco significativo de desenvolver aneurismas ou disseções da aorta, apesar do risco elevado do viés. Isto deve ser tido em conta aquando do tratamento destes doentes.
Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) has several renal and extra-renal manifestations. Studies have reported a higher incidence of aortic aneurysms (AA) / aortic dissection (AD) in these patients, however, an association has never been established. The aim of this study was to conduct a systematic review and meta-analysis of observational studies analyzing the risk of AA/AD in ADPKD patients. Methods: We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey from inception to May 2021 for observational studies reporting frequency estimates of AA/AD in patients with ADPKD compared with controls. Article screening and data extraction were performed by two authors and data was pooled using a random-effects model. Primary outcome was the odds ratio (OR) of the existence of an AA/AD in patients with ADPKD compared to controls. Secondary outcomes were the odds of having an AA in patients with ADPKD compared to controls, the odds of having an AD in patients with ADPKD compared to controls, differences among subtypes of AA (different locations of the aorta) or AD (type A or type B), differences according to age, differences among male and female patients, differences across different study designs. Results: Seven observational studies were included. ADPKD was associated with a higher risk of AA or AD comparing with a population without the disease (OR: 4.33; 95% CI 2.69; 6.97, p < 0.001); higher risk of AA (OR: 4.18; 95% CI 2.36;7.40, p <0.001) and higher risk of AD (OR 9.08; 95% CI 3.11;26.55, p<0.001). Conclusions: ADPKD was associated with a significant risk of having/developing an aortic aneurysm or dissection. However, the risk of bias of included studies was considered high and these results should be interpreted cautiously. Even so, this association should be pondered when treating a patient with this condition.
Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) has several renal and extra-renal manifestations. Studies have reported a higher incidence of aortic aneurysms (AA) / aortic dissection (AD) in these patients, however, an association has never been established. The aim of this study was to conduct a systematic review and meta-analysis of observational studies analyzing the risk of AA/AD in ADPKD patients. Methods: We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey from inception to May 2021 for observational studies reporting frequency estimates of AA/AD in patients with ADPKD compared with controls. Article screening and data extraction were performed by two authors and data was pooled using a random-effects model. Primary outcome was the odds ratio (OR) of the existence of an AA/AD in patients with ADPKD compared to controls. Secondary outcomes were the odds of having an AA in patients with ADPKD compared to controls, the odds of having an AD in patients with ADPKD compared to controls, differences among subtypes of AA (different locations of the aorta) or AD (type A or type B), differences according to age, differences among male and female patients, differences across different study designs. Results: Seven observational studies were included. ADPKD was associated with a higher risk of AA or AD comparing with a population without the disease (OR: 4.33; 95% CI 2.69; 6.97, p < 0.001); higher risk of AA (OR: 4.18; 95% CI 2.36;7.40, p <0.001) and higher risk of AD (OR 9.08; 95% CI 3.11;26.55, p<0.001). Conclusions: ADPKD was associated with a significant risk of having/developing an aortic aneurysm or dissection. However, the risk of bias of included studies was considered high and these results should be interpreted cautiously. Even so, this association should be pondered when treating a patient with this condition.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Doença renal poliquística autossómica ominante Aneurismas da aorta Disseções aórticas Revisão sistemática Meta-análise Cardiologia