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Flow chart: 2023 review update study selection

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Figure 1

Flow chart: 2023 review update study selection

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

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Analysis 1.1

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

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Analysis 1.2

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

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Analysis 1.3

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

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Analysis 1.4

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

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Analysis 1.5

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

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Analysis 1.6

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

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Analysis 1.7

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

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Analysis 1.8

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

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Analysis 1.9

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

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Analysis 1.10

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

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Analysis 1.11

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

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Analysis 1.12

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

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Analysis 1.13

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

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Analysis 1.14

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 15: Proteinuria at end of study

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Analysis 1.15

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 15: Proteinuria at end of study

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 16: Change in proteinuria

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Analysis 1.16

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 16: Change in proteinuria

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 17: Albuminuria at end of study

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Analysis 1.17

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 17: Albuminuria at end of study

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 18: Change in albuminuria

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Analysis 1.18

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 18: Change in albuminuria

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 19: Vascular access thrombosis

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Analysis 1.19

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 19: Vascular access thrombosis

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 20: Graft loss

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Analysis 1.20

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 20: Graft loss

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 21: Graft failure

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Analysis 1.21

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 21: Graft failure

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 22: Delayed graft function

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Analysis 1.22

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 22: Delayed graft function

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 23: Malignancy

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Analysis 1.23

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 23: Malignancy

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 24: Major bleeding

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Analysis 1.24

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 24: Major bleeding

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 25: Infection

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Analysis 1.25

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 25: Infection

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 26: Sensitivity analysis: change in eGFR without imputed SD

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Analysis 1.26

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 26: Sensitivity analysis: change in eGFR without imputed SD

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 27: Sensitivity analysis: change in serum creatinine without imputed SD

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Analysis 1.27

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 27: Sensitivity analysis: change in serum creatinine without imputed SD

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 28: Sensitivity analysis: change in urinary albumin/creatinine ratio without imputed SD

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Analysis 1.28

Comparison 1: Antioxidants versus placebo or standard therapy, Outcome 28: Sensitivity analysis: change in urinary albumin/creatinine ratio without imputed SD

Comparison 2: Pomegranate juice versus pomegranate extract, Outcome 1: Death (any cause)

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Analysis 2.1

Comparison 2: Pomegranate juice versus pomegranate extract, Outcome 1: Death (any cause)

Comparison 3: Zinc acetate versus polaprezinc, Outcome 1: Death (any cause)

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Analysis 3.1

Comparison 3: Zinc acetate versus polaprezinc, Outcome 1: Death (any cause)

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

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Analysis 4.1

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

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Analysis 4.2

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

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Analysis 4.3

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

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Analysis 4.4

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

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Analysis 4.5

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

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Analysis 4.6

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

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Analysis 4.7

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

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Analysis 4.8

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

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Analysis 4.9

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

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Analysis 4.10

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

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Analysis 4.11

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

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Analysis 4.12

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

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Analysis 4.13

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

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Analysis 4.14

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 15: Albuminuria at end of study

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Analysis 4.15

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 15: Albuminuria at end of study

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 16: Change in albuminuria

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Analysis 4.16

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 16: Change in albuminuria

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 17: Vascular access thrombosis

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Analysis 4.17

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 17: Vascular access thrombosis

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 18: Graft loss

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Analysis 4.18

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 18: Graft loss

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 19: Delayed graft function

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Analysis 4.19

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 19: Delayed graft function

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 20: Malignancy

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Analysis 4.20

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 20: Malignancy

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 21: Major bleeding

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Analysis 4.21

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 21: Major bleeding

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 22: Infection

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Analysis 4.22

Comparison 4: Vitamin antioxidants versus placebo or standard therapy, Outcome 22: Infection

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

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Analysis 5.1

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 1: Cardiovascular death

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

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Analysis 5.2

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 2: Death (any cause)

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

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Analysis 5.3

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 3: Cardiovascular disease

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

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Analysis 5.4

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 4: Coronary heart disease

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

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Analysis 5.5

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 5: Heart failure

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

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Analysis 5.6

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 6: Cerebrovascular disease

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

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Analysis 5.7

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 7: Peripheral vascular disease

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

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Analysis 5.8

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 8: Kidney failure

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

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Analysis 5.9

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 9: eGFR at end of study

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

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Analysis 5.10

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 10: Change in eGFR

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

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Analysis 5.11

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 11: Serum creatinine at end of study

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

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Analysis 5.12

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 12: Change in serum creatinine

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

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Analysis 5.13

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 13: Urinary albumin/creatinine ratio at end of study

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

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Analysis 5.14

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 14: Change in urinary albumin/creatinine ratio

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 15: Proteinuria at end of study

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Analysis 5.15

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 15: Proteinuria at end of study

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 16: Change in proteinuria

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Analysis 5.16

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 16: Change in proteinuria

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 17: Albuminuria at end of study

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Analysis 5.17

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 17: Albuminuria at end of study

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 18: Change in albuminuria

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Analysis 5.18

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 18: Change in albuminuria

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 19: Graft loss

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Analysis 5.19

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 19: Graft loss

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 20: Graft failure

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Analysis 5.20

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 20: Graft failure

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 21: Delayed graft function

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Analysis 5.21

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 21: Delayed graft function

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 22: Malignancy

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Analysis 5.22

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 22: Malignancy

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 23: Major bleeding

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Analysis 5.23

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 23: Major bleeding

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 24: Infection

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Analysis 5.24

Comparison 5: Non‐vitamin antioxidants versus placebo or standard therapy, Outcome 24: Infection

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 1: Cardiovascular death

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Analysis 6.1

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 1: Cardiovascular death

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 2: Death (any cause)

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Analysis 6.2

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 2: Death (any cause)

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 3: Cardiovascular disease

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Analysis 6.3

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 3: Cardiovascular disease

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 4: Coronary heart disease

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Analysis 6.4

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 4: Coronary heart disease

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 5: Heart failure

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Analysis 6.5

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 5: Heart failure

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 6: Cerebrovascular disease

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Analysis 6.6

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 6: Cerebrovascular disease

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 7: Peripheral vascular disease

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Analysis 6.7

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 7: Peripheral vascular disease

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 8: Kidney failure

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Analysis 6.8

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 8: Kidney failure

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 9: eGFR at end of study

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Analysis 6.9

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 9: eGFR at end of study

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 10: Change in eGFR

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Analysis 6.10

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 10: Change in eGFR

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 11: Serum creatinine at end of study

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Analysis 6.11

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 11: Serum creatinine at end of study

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 12: Change in serum creatinine

Figuras y tablas -
Analysis 6.12

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 12: Change in serum creatinine

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 13: Urinary albumin/creatinine ratio at end of study

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Analysis 6.13

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 13: Urinary albumin/creatinine ratio at end of study

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 14: Change in urinary albumin/creatinine ratio

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Analysis 6.14

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 14: Change in urinary albumin/creatinine ratio

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 15: Proteinuria at end of study

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Analysis 6.15

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 15: Proteinuria at end of study

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 16: Change in proteinuria

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Analysis 6.16

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 16: Change in proteinuria

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 17: Albuminuria at end of study

Figuras y tablas -
Analysis 6.17

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 17: Albuminuria at end of study

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 18: Change in albuminuria

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Analysis 6.18

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 18: Change in albuminuria

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 19: Vascular access thrombosis

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Analysis 6.19

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 19: Vascular access thrombosis

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 20: Graft loss

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Analysis 6.20

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 20: Graft loss

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 21: Delayed graft function

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Analysis 6.21

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 21: Delayed graft function

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 22: Malignancy

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Analysis 6.22

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 22: Malignancy

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 23: Major bleeding

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Analysis 6.23

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 23: Major bleeding

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 24: Infection

Figuras y tablas -
Analysis 6.24

Comparison 6: Antioxidants versus placebo or standard therapy: low risk of bias, Outcome 24: Infection

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 1: Cardiovascular death

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Analysis 7.1

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 1: Cardiovascular death

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 2: Death (any cause)

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Analysis 7.2

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 2: Death (any cause)

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 3: Cardiovascular disease

Figuras y tablas -
Analysis 7.3

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 3: Cardiovascular disease

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 4: Coronary heart disease

Figuras y tablas -
Analysis 7.4

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 4: Coronary heart disease

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 5: Heart failure

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Analysis 7.5

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 5: Heart failure

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 6: Cerebrovascular disease

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Analysis 7.6

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 6: Cerebrovascular disease

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 7: Peripheral vascular disease

Figuras y tablas -
Analysis 7.7

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 7: Peripheral vascular disease

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 8: Kidney failure

Figuras y tablas -
Analysis 7.8

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 8: Kidney failure

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 9: eGFR at end of study

Figuras y tablas -
Analysis 7.9

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 9: eGFR at end of study

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 10: Change in eGFR

Figuras y tablas -
Analysis 7.10

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 10: Change in eGFR

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 11: Serum creatinine at end of study

Figuras y tablas -
Analysis 7.11

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 11: Serum creatinine at end of study

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 12: Change in serum creatinine

Figuras y tablas -
Analysis 7.12

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 12: Change in serum creatinine

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 13: Urinary albumin/creatinine ratio at end of study

Figuras y tablas -
Analysis 7.13

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 13: Urinary albumin/creatinine ratio at end of study

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 14: Change in urinary albumin/creatinine ratio

Figuras y tablas -
Analysis 7.14

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 14: Change in urinary albumin/creatinine ratio

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 15: Proteinuria at end of study

Figuras y tablas -
Analysis 7.15

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 15: Proteinuria at end of study

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 16: Change in proteinuria

Figuras y tablas -
Analysis 7.16

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 16: Change in proteinuria

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 17: Albuminuria at end of study

Figuras y tablas -
Analysis 7.17

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 17: Albuminuria at end of study

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 18: Change in albuminuria

Figuras y tablas -
Analysis 7.18

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 18: Change in albuminuria

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 19: Vascular access thrombosis

Figuras y tablas -
Analysis 7.19

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 19: Vascular access thrombosis

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 20: Graft loss

Figuras y tablas -
Analysis 7.20

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 20: Graft loss

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 21: Graft failure

Figuras y tablas -
Analysis 7.21

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 21: Graft failure

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 22: Delayed graft function

Figuras y tablas -
Analysis 7.22

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 22: Delayed graft function

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 23: Malignancy

Figuras y tablas -
Analysis 7.23

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 23: Malignancy

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 24: Major bleeding

Figuras y tablas -
Analysis 7.24

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 24: Major bleeding

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 25: Infection

Figuras y tablas -
Analysis 7.25

Comparison 7: Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more, Outcome 25: Infection

Summary of findings 1. Antioxidants versus control for adults with chronic kidney disease

Antioxidants versus control for adults with chronic kidney disease

Patient or population: adults with CKD

Settings: all settings

Intervention: antioxidants

Comparison: control (placebo, usual care, no treatment)

Outcomes

Anticipated absolute effects (95% CI)

Relative effect (95% CI)

No. of participants
(RCTs)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Antioxidants

Cardiovascular death

Follow‐up: 12 weeks to 2.25 years (median 9.8 months)

All adults (CKD 3‐5, CKD 5D, CKD 5‐transplant)

RR 0.94

(0.64 to 1.40)

3813 (8)

Low5

⊕⊕⊝⊝

59 per 1000

56 per 1000

(38 to 83)

CKD 3‐5

RR 0.89

(0.46 to 1.74)

3269 (3)

Very low1,2,3

⊕⊝⊝⊝

53 per 1000

47 per 1000

(24 to 91)

CKD 5D

RR 0.84

(0.49 to 1.44)

444 (4)

Moderate1

⊕⊕⊕⊝

119 per 1000

100 per 1000

(59 to 172)

CKD 5‐transplant

RR 5.00

(0.25 to 101.58)

100 (1)

Very low1,7

⊕⊝⊝⊝

0 per 1000

0 per 1000

(0 to 0)

Death (any cause)

Follow‐up: 1 month to 5 years (median 6 months)

All adults (CKD 3‐5, CKD 5D, CKD 5‐transplant)

RR 0.95

(0.82 to 1.11)

7530 (45)

Moderate1

⊕⊕⊕⊝

79 per 1000

75 per 1000

(65 to 87)

CKD 3‐5

RR 0.1.00

(0.82 to 1.20)

4229 (13)

Low5

⊕⊕⊝⊝

77 per 1000

77 per 1000

(63 to 93)

CKD 5D

RR 0.92

(0.69 to 1.22)

2261 (21)

Moderate1

⊕⊕⊕⊝

81 per 1000

75 per 1000

(59 to 99)

CKD 5‐transplant

RR 0.82

(0.53 to 1.28)

1040 (11)

Very low3,5

⊕⊝⊝⊝

80 per 1000

65 per 1000

(42 to 102)

Cardiovascular disease

Follow‐up: 12 weeks to 2 years (median 11 months)

All adults (CKD 3‐5, CKD 5D, CKD 5‐transplant)

RR 0.79

(0.63 to 0.99)

4768 (16)

Moderate1

⊕⊕⊕⊝

120 per 1000

95 per 1000

(76 to 119)

CKD 3‐5

RR 0.76

(0.59 to 0.99)

4050 (8)

Moderate1

⊕⊕⊕⊝

126 per 1000

96 per 1000

(75 to 125)

CKD 5D

RR 0.87

(0.47 to 1.62)

557 (6)

Low1,3

⊕⊕⊝⊝

104 per 1000

91 per 1000

(49 to 169)

CKD 5‐transplant

RR 5.00

(0.25 to 101.58)

161 (2)

Very low5,7

⊕⊝⊝⊝

0 per 1000

0 per 1000

(0 to 0)

Heart failure

Follow‐up: 16 weeks to 2 years (median 12 months)

All adults (CKD 3‐5, CKD 5D, CKD 5‐transplant)

RR 1.40

(1.11 to 1.76)

3733 (6)

Moderate1

⊕⊕⊕⊝

62 per 1000

86 per 1000

(68 to 108)

CKD 3‐5

RR 1.40

(1.11 to 1.76)

3733 (6)

Moderate1

⊕⊕⊕⊝

62 per 1000

86 per 1000

(68 to 108)

CKD 5D

No evidence

CKD 5‐transplant

No evidence

Kidney failure

Follow‐up: 3 months to 5 years (median 12 months)

All adults (CKD 3‐5, CKD 5‐transplant)

RR 0.65

(0.41 to 1.02)

3201 (10)

Moderate1

⊕⊕⊕⊝

77 per 1000

50 per 1000

(31 to 78)

CKD 3‐5

RR 0.68

(0.40 to 1.17)

3024 (9)

Moderate1

⊕⊕⊕⊝

68 per 1000

46 per 1000

(27 to 80)

CKD 5‐transplant

RR 0.53

(0.26 to 1.11)

177 (1)

Low1,3

⊕⊕⊝⊝

208 per 1000

110 per 1000

(54 to 231)

Change in eGFR (mL/min/1.73 m²)

Follow‐up: 2 days to 2 years (median 6 months)

All adults (CKD 3‐5, CKD 5‐transplant)

4128 (28)

Very low1,4,6

⊕⊝⊝⊝

The mean change in eGFR was 3.65 higher with antioxidants than control

(2.81 higher to 4.50 higher)

CKD 3‐5

4057 (26)

Very low1,4,6

⊕⊝⊝⊝

The mean change in eGFR was 3.72 higher with antioxidants than control

(2.85 higher to 4.58 higher)

CKD 5‐transplant

71 (2)

Very low1,2,3,4

⊕⊝⊝⊝

The mean change in eGFR was 3.97 higher with antioxidants than control

(4.18 lower to 12.13 higher)

Graft loss

Follow‐up: 1 month to 5 years (median 12 months)

CKD 5‐transplant

RR 0.88

(0.67 to 1.17)

1053 (11)

Moderate1

⊕⊕⊕⊝

155 per 1000

136 per 1000

Infection

Follow‐up: 7 days to 3 years (median 12 months)

All adults (CKD 3‐5, CKD 5‐transplant)

RR 1.30

(1.14 to 1.50)

3697 (14)

Moderate1

⊕⊕⊕⊝

189 per 1000

246 per 1000

(216 to 284)

CKD 3‐5

RR 1.46

(1.28 to 1.66)

2802 (6)

Moderate1

⊕⊕⊕⊝

203 per 1000

297 per 1000

(260 to 337)

CKD 5D

RR 1.39

(0.73 to 2.65)

616 (5)

Very low1,7

⊕⊝⊝⊝

51 per 1000

72 per 1000

(253 to 418)

CKD 5‐transplant

RR 1.00

(0.78 to 1.29)

279 (3)

Moderate1

⊕⊕⊕⊝

324 per 1000

324 per 1000

(253 to 418)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CKD: chronic kidney disease; CI: confidence interval; RR: risk ratio; eGFR: estimated glomerular filtration rate

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Evidence certainty was downgraded by one level due to risk of bias

2 Evidence certainty was downgraded by one level due to inconsistency (due to substantial heterogeneity (I² ranged from 50% to 90%)

3 Evidence certainty was downgraded by one level due to imprecision in CIs

4 Evidence certainty was downgraded by one level due to possible publication bias

5 Evidence certainty was downgraded by two levels due to risk of bias and difference in estimates in analysis with all studies and analysis with only studies with low risk of bias

6 Evidence certainty was downgraded by two levels for inconsistency due to considerable heterogeneity (I² ≥ 90%)

7 Evidence certainty was downgraded by two levels due to very large imprecision in CIs

Figuras y tablas -
Summary of findings 1. Antioxidants versus control for adults with chronic kidney disease
Comparison 1. Antioxidants versus placebo or standard therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Cardiovascular death Show forest plot

8

3813

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.64, 1.40]

1.1.1 CKD stages 3‐5

3

3269

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.46, 1.74]

1.1.2 CKD stage 5D

4

444

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.49, 1.44]

1.1.3 Kidney transplant

1

100

Risk Ratio (M‐H, Random, 95% CI)

5.00 [0.25, 101.58]

1.2 Death (any cause) Show forest plot

45

7530

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.82, 1.11]

1.2.1 CKD stages 3‐5

13

4229

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.82, 1.20]

1.2.2 CKD stage 5D

21

2261

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.69, 1.22]

1.2.3 Kidney transplant

11

1040

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.53, 1.28]

1.3 Cardiovascular disease Show forest plot

16

4768

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.63, 0.99]

1.3.1 CKD stages 3‐5

8

4050

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.59, 0.99]

1.3.2 CKD stage 5D

6

557

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.47, 1.62]

1.3.3 Kidney transplant

2

161

Risk Ratio (M‐H, Random, 95% CI)

5.00 [0.25, 101.58]

1.4 Coronary heart disease Show forest plot

12

4372

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.64, 1.12]

1.4.1 CKD stages 3‐5

7

3811

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.76, 1.24]

1.4.2 CKD stage 5D

6

561

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.30, 1.15]

1.5 Heart failure Show forest plot

6

3733

Risk Ratio (M‐H, Random, 95% CI)

1.40 [1.11, 1.76]

1.5.1 CKD stages 3‐5

6

3733

Risk Ratio (M‐H, Random, 95% CI)

1.40 [1.11, 1.76]

1.6 Cerebrovascular disease Show forest plot

8

1768

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.71, 1.32]

1.6.1 CKD stages 3‐5

3

1147

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.71, 1.38]

1.6.2 CKD stage 5D

4

521

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.31, 1.98]

1.6.3 Kidney transplant

1

100

Risk Ratio (M‐H, Random, 95% CI)

3.00 [0.13, 71.92]

1.7 Peripheral vascular disease Show forest plot

4

1492

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.41, 1.47]

1.7.1 CKD stages 3‐5

2

1162

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.34, 2.90]

1.7.2 CKD stage 5D

2

330

Risk Ratio (M‐H, Random, 95% CI)

0.54 [0.26, 1.12]

1.8 Kidney failure Show forest plot

10

3201

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.41, 1.02]

1.8.1 CKD stages 3‐5

9

3024

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.40, 1.17]

1.8.2 Kidney transplant

1

177

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.26, 1.11]

1.9 eGFR at end of study Show forest plot

32

2435

Mean Difference (IV, Random, 95% CI)

3.85 [2.13, 5.56]

1.9.1 CKD stages 3‐5

22

1597

Mean Difference (IV, Random, 95% CI)

3.51 [1.47, 5.54]

1.9.2 Kidney transplant

10

838

Mean Difference (IV, Random, 95% CI)

4.75 [1.46, 8.04]

1.10 Change in eGFR Show forest plot

28

4128

Mean Difference (IV, Random, 95% CI)

3.65 [2.81, 4.50]

1.10.1 CKD stages 3‐5

26

4057

Mean Difference (IV, Random, 95% CI)

3.72 [2.85, 4.58]

1.10.2 Kidney transplant

2

71

Mean Difference (IV, Random, 95% CI)

3.97 [‐4.18, 12.13]

1.11 Serum creatinine at end of study Show forest plot

22

1587

Mean Difference (IV, Random, 95% CI)

‐6.24 [‐15.71, 3.23]

1.11.1 CKD stages 3‐5

9

562

Mean Difference (IV, Random, 95% CI)

1.70 [‐12.38, 15.79]

1.11.2 Kidney transplant

13

1025

Mean Difference (IV, Random, 95% CI)

‐13.87 [‐28.02, 0.28]

1.12 Change in serum creatinine Show forest plot

16

3180

Mean Difference (IV, Random, 95% CI)

‐13.35 [‐23.49, ‐3.20]

1.12.1 CKD stages 3‐5

11

2970

Mean Difference (IV, Random, 95% CI)

‐13.64 [‐24.75, ‐2.53]

1.12.2 Kidney transplant

5

210

Mean Difference (IV, Random, 95% CI)

‐18.90 [‐46.82, 9.01]

1.13 Urinary albumin/creatinine ratio at end of study Show forest plot

5

1174

Mean Difference (IV, Random, 95% CI)

‐0.59 [‐12.78, 11.59]

1.13.1 CKD stages 3‐5

5

1174

Mean Difference (IV, Random, 95% CI)

‐0.59 [‐12.78, 11.59]

1.14 Change in urinary albumin/creatinine ratio Show forest plot

7

1286

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.55, 0.47]

1.14.1 CKD stages 3‐5

7

1286

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.55, 0.47]

1.15 Proteinuria at end of study Show forest plot

9

536

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.78, 0.31]

1.15.1 CKD stages 3‐5

9

536

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.78, 0.31]

1.16 Change in proteinuria Show forest plot

8

468

Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.11, 0.09]

1.16.1 CKD stages 3‐5

8

468

Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.11, 0.09]

1.17 Albuminuria at end of study Show forest plot

4

395

Mean Difference (IV, Random, 95% CI)

94.75 [0.57, 188.94]

1.17.1 CKD stages 3‐5

4

395

Mean Difference (IV, Random, 95% CI)

94.75 [0.57, 188.94]

1.18 Change in albuminuria Show forest plot

4

395

Mean Difference (IV, Random, 95% CI)

‐87.08 [‐221.12, 46.97]

1.18.1 CKD stages 3‐5

4

395

Mean Difference (IV, Random, 95% CI)

‐87.08 [‐221.12, 46.97]

1.19 Vascular access thrombosis Show forest plot

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

1.19.1 CKD stage 5D

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

1.20 Graft loss Show forest plot

11

1053

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.67, 1.17]

1.20.1 Kidney transplant

11

1053

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.67, 1.17]

1.21 Graft failure Show forest plot

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

1.21.1 Kidney transplant

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

1.22 Delayed graft function Show forest plot

11

859

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.75, 1.09]

1.22.1 Kidney transplant

11

859

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.75, 1.09]

1.23 Malignancy Show forest plot

3

507

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.12, 3.63]

1.23.1 CKD stages 3‐5

1

227

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.05, 2.33]

1.23.2 CKD stage 5D

2

280

Risk Ratio (M‐H, Random, 95% CI)

1.33 [0.09, 20.26]

1.24 Major bleeding Show forest plot

6

449

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.41, 3.12]

1.24.1 CKD stages 3‐5

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.07, 5.97]

1.24.2 CKD stage 5D

4

353

Risk Ratio (M‐H, Random, 95% CI)

1.55 [0.45, 5.31]

1.25 Infection Show forest plot

14

3697

Risk Ratio (M‐H, Random, 95% CI)

1.30 [1.14, 1.50]

1.25.1 CKD stages 3‐5

6

2802

Risk Ratio (M‐H, Random, 95% CI)

1.46 [1.28, 1.66]

1.25.2 CKD stage 5D

5

616

Risk Ratio (M‐H, Random, 95% CI)

1.39 [0.73, 2.65]

1.25.3 Kidney transplant

3

279

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.78, 1.29]

1.26 Sensitivity analysis: change in eGFR without imputed SD Show forest plot

9

3024

Mean Difference (IV, Random, 95% CI)

4.17 [2.93, 5.42]

1.26.1 CKD stages 3‐5

8

3014

Mean Difference (IV, Random, 95% CI)

4.09 [2.84, 5.34]

1.26.3 Kidney transplant

1

10

Mean Difference (IV, Random, 95% CI)

9.60 [0.12, 19.08]

1.27 Sensitivity analysis: change in serum creatinine without imputed SD Show forest plot

3

297

Mean Difference (IV, Random, 95% CI)

‐0.12 [‐13.90, 13.65]

1.27.1 CKD stages 3‐5

2

287

Mean Difference (IV, Random, 95% CI)

‐5.43 [‐25.61, 14.74]

1.27.3 Kidney transplant

1

10

Mean Difference (IV, Random, 95% CI)

11.30 [‐7.76, 30.36]

1.28 Sensitivity analysis: change in urinary albumin/creatinine ratio without imputed SD Show forest plot

2

145

Mean Difference (IV, Random, 95% CI)

0.00 [‐0.14, 0.14]

1.28.1 CKD stages 3‐5

2

145

Mean Difference (IV, Random, 95% CI)

0.00 [‐0.14, 0.14]

Figuras y tablas -
Comparison 1. Antioxidants versus placebo or standard therapy
Comparison 2. Pomegranate juice versus pomegranate extract

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Death (any cause) Show forest plot

1

24

Risk Ratio (M‐H, Random, 95% CI)

Not estimable

Figuras y tablas -
Comparison 2. Pomegranate juice versus pomegranate extract
Comparison 3. Zinc acetate versus polaprezinc

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Death (any cause) Show forest plot

1

91

Risk Ratio (M‐H, Random, 95% CI)

11.73 [0.67, 206.19]

Figuras y tablas -
Comparison 3. Zinc acetate versus polaprezinc
Comparison 4. Vitamin antioxidants versus placebo or standard therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Cardiovascular death Show forest plot

3

1223

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.59, 1.28]

4.1.1 CKD stages 3‐5

1

993

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.70, 1.40]

4.1.2 CKD stage 5D

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.27, 1.21]

4.2 Death (any cause) Show forest plot

13

2469

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.74, 1.14]

4.2.1 CKD stages 3‐5

2

1054

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.69, 1.18]

4.2.2 CKD stage 5D

10

1353

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.67, 1.42]

4.2.3 Kidney transplant

1

62

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.10, 2.53]

4.3 Cardiovascular disease Show forest plot

7

1658

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.49, 1.32]

4.3.1 CKD stages 3‐5

3

1282

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.38, 1.30]

4.3.2 CKD stage 5D

4

376

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.41, 3.59]

4.4 Coronary heart disease Show forest plot

6

1457

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.29, 1.26]

4.4.1 CKD stages 3‐5

3

1110

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.50, 1.52]

4.4.2 CKD stage 5D

4

347

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.12, 1.75]

4.5 Heart failure Show forest plot

1

993

Risk Ratio (M‐H, Random, 95% CI)

1.30 [0.96, 1.77]

4.5.1 CKD stages 3‐5

1

993

Risk Ratio (M‐H, Random, 95% CI)

1.30 [0.96, 1.77]

4.6 Cerebrovascular disease Show forest plot

5

1454

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.72, 1.37]

4.6.1 CKD stages 3‐5

3

1147

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.71, 1.38]

4.6.2 CKD stage 5D

2

307

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.35, 3.06]

4.7 Peripheral vascular disease Show forest plot

2

1189

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.28, 2.37]

4.7.1 CKD stages 3‐5

1

993

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.93, 1.55]

4.7.2 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.10, 1.40]

4.8 Kidney failure Show forest plot

1

93

Risk Ratio (M‐H, Random, 95% CI)

1.63 [0.41, 6.43]

4.8.1 CKD stages 3‐5

1

93

Risk Ratio (M‐H, Random, 95% CI)

1.63 [0.41, 6.43]

4.9 eGFR at end of study Show forest plot

6

387

Mean Difference (IV, Random, 95% CI)

0.59 [‐5.97, 7.16]

4.9.1 CKD stages 3‐5

4

241

Mean Difference (IV, Random, 95% CI)

‐1.70 [‐9.28, 5.88]

4.9.2 Kidney transplant

2

146

Mean Difference (IV, Random, 95% CI)

6.45 [4.88, 8.02]

4.10 Change in eGFR Show forest plot

5

251

Mean Difference (IV, Random, 95% CI)

2.42 [‐0.26, 5.10]

4.10.1 CKD stages 3‐5

4

241

Mean Difference (IV, Random, 95% CI)

1.96 [‐0.78, 4.70]

4.10.2 Kidney transplant

1

10

Mean Difference (IV, Random, 95% CI)

9.60 [0.12, 19.08]

4.11 Serum creatinine at end of study Show forest plot

3

133

Mean Difference (IV, Random, 95% CI)

0.51 [‐11.36, 12.38]

4.11.1 CKD stages 3‐5

1

61

Mean Difference (IV, Random, 95% CI)

7.00 [‐12.83, 26.83]

4.11.2 Kidney transplant

2

72

Mean Difference (IV, Random, 95% CI)

‐3.12 [‐17.93, 11.70]

4.12 Change in serum creatinine Show forest plot

2

71

Mean Difference (IV, Random, 95% CI)

4.85 [‐4.14, 13.84]

4.12.1 CKD stages 3‐5

1

61

Mean Difference (IV, Random, 95% CI)

3.00 [‐7.20, 13.20]

4.12.2 Kidney transplant

1

10

Mean Difference (IV, Random, 95% CI)

11.30 [‐7.76, 30.36]

4.13 Urinary albumin/creatinine ratio at end of study Show forest plot

2

1054

Mean Difference (IV, Random, 95% CI)

0.17 [‐2.74, 3.08]

4.13.1 CKD stages 3‐5

2

1054

Mean Difference (IV, Random, 95% CI)

0.17 [‐2.74, 3.08]

4.14 Change in urinary albumin/creatinine ratio Show forest plot

2

1054

Mean Difference (IV, Random, 95% CI)

2.73 [‐6.87, 12.32]

4.14.1 CKD stages 3‐5

2

1054

Mean Difference (IV, Random, 95% CI)

2.73 [‐6.87, 12.32]

4.15 Albuminuria at end of study Show forest plot

1

93

Mean Difference (IV, Random, 95% CI)

‐30.00 [‐342.31, 282.31]

4.15.1 CKD stages 3‐5

1

93

Mean Difference (IV, Random, 95% CI)

‐30.00 [‐342.31, 282.31]

4.16 Change in albuminuria Show forest plot

1

93

Mean Difference (IV, Random, 95% CI)

‐4.00 [‐217.48, 209.48]

4.16.1 CKD stages 3‐5

1

93

Mean Difference (IV, Random, 95% CI)

‐4.00 [‐217.48, 209.48]

4.17 Vascular access thrombosis Show forest plot

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

4.17.1 CKD stage 5D

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

4.18 Graft loss Show forest plot

1

62

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.08, 1.91]

4.18.1 Kidney transplant

1

62

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.08, 1.91]

4.19 Delayed graft function Show forest plot

2

146

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.49, 1.60]

4.19.1 Kidney transplant

2

146

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.49, 1.60]

4.20 Malignancy Show forest plot

1

196

Risk Ratio (M‐H, Random, 95% CI)

5.10 [0.25, 104.92]

4.20.1 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

5.10 [0.25, 104.92]

4.21 Major bleeding Show forest plot

2

238

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.22, 7.52]

4.21.1 CKD stage 5D

2

238

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.22, 7.52]

4.22 Infection Show forest plot

5

606

Risk Ratio (M‐H, Random, 95% CI)

1.39 [0.73, 2.64]

4.22.1 CKD stages 3‐5

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.06, 14.78]

4.22.2 CKD stage 5D

4

545

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.73, 2.74]

Figuras y tablas -
Comparison 4. Vitamin antioxidants versus placebo or standard therapy
Comparison 5. Non‐vitamin antioxidants versus placebo or standard therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Cardiovascular death Show forest plot

5

2590

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.52, 2.19]

5.1.1 CKD stages 3‐5

2

2276

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.08, 4.19]

5.1.2 CKD stage 5D

2

214

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.58, 2.83]

5.1.3 Kidney transplant

1

100

Risk Ratio (M‐H, Random, 95% CI)

5.00 [0.25, 101.58]

5.2 Death (any cause) Show forest plot

32

5061

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.80, 1.21]

5.2.1 CKD stages 3‐5

11

3175

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.84, 1.45]

5.2.2 CKD stage 5D

11

908

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.55, 1.31]

5.2.3 Kidney transplant

10

978

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.54, 1.35]

5.3 Cardiovascular disease Show forest plot

9

3110

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.56, 0.93]

5.3.1 CKD stages 3‐5

5

2768

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.55, 0.96]

5.3.2 CKD stage 5D

2

181

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.29]

5.3.3 Kidney transplant

2

161

Risk Ratio (M‐H, Random, 95% CI)

5.00 [0.25, 101.58]

5.4 Coronary heart disease Show forest plot

6

2915

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.61, 1.48]

5.4.1 CKD stages 3‐5

4

2701

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.63, 1.96]

5.4.2 CKD stage 5D

2

214

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.36, 1.50]

5.5 Heart failure Show forest plot

5

2740

Risk Ratio (M‐H, Random, 95% CI)

1.55 [1.09, 2.20]

5.5.1 CKD stages 3‐5

5

2740

Risk Ratio (M‐H, Random, 95% CI)

1.55 [1.09, 2.20]

5.6 Cerebrovascular disease Show forest plot

3

314

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.16, 4.11]

5.6.1 CKD stage 5D

2

214

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.08, 4.79]

5.6.2 Kidney transplant

1

100

Risk Ratio (M‐H, Random, 95% CI)

3.00 [0.13, 71.92]

5.7 Peripheral vascular disease Show forest plot

2

303

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.25, 1.35]

5.7.1 CKD stages 3‐5

1

169

Risk Ratio (M‐H, Random, 95% CI)

0.21 [0.01, 4.35]

5.7.2 CKD stage 5D

1

134

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.27, 1.52]

5.8 Kidney failure Show forest plot

9

3108

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.38, 0.96]

5.8.1 CKD stages 3‐5

8

2931

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.35, 1.10]

5.8.2 Kidney transplant

1

177

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.26, 1.11]

5.9 eGFR at end of study Show forest plot

26

2048

Mean Difference (IV, Random, 95% CI)

4.71 [2.88, 6.54]

5.9.1 CKD stages 3‐5

18

1356

Mean Difference (IV, Random, 95% CI)

4.83 [2.75, 6.91]

5.9.3 Kidney transplant

8

692

Mean Difference (IV, Random, 95% CI)

4.55 [0.27, 8.83]

5.10 Change in eGFR Show forest plot

23

3877

Mean Difference (IV, Random, 95% CI)

3.98 [3.09, 4.87]

5.10.1 CKD stages 3‐5

22

3816

Mean Difference (IV, Random, 95% CI)

4.12 [3.21, 5.03]

5.10.3 Kidney transplant

1

61

Mean Difference (IV, Random, 95% CI)

0.90 [‐1.25, 3.05]

5.11 Serum creatinine at end of study Show forest plot

19

1454

Mean Difference (IV, Random, 95% CI)

‐7.01 [‐17.44, 3.42]

5.11.1 CKD stages 3‐5

8

501

Mean Difference (IV, Random, 95% CI)

1.01 [‐13.92, 15.94]

5.11.3 Kidney transplant

11

953

Mean Difference (IV, Random, 95% CI)

‐15.59 [‐32.52, 1.34]

5.12 Change in serum creatinine Show forest plot

14

3109

Mean Difference (IV, Random, 95% CI)

‐16.32 [‐26.87, ‐5.78]

5.12.1 CKD stages 3‐5

10

2909

Mean Difference (IV, Random, 95% CI)

‐15.48 [‐26.84, ‐4.12]

5.12.3 Kidney transplant

4

200

Mean Difference (IV, Random, 95% CI)

‐31.39 [‐68.88, 6.09]

5.13 Urinary albumin/creatinine ratio at end of study Show forest plot

3

120

Mean Difference (IV, Random, 95% CI)

‐61.20 [‐152.33, 29.94]

5.13.1 CKD stages 3‐5

3

120

Mean Difference (IV, Random, 95% CI)

‐61.20 [‐152.33, 29.94]

5.14 Change in urinary albumin/creatinine ratio Show forest plot

5

232

Mean Difference (IV, Random, 95% CI)

‐0.92 [‐7.59, 5.76]

5.14.1 CKD stages 3‐5

5

232

Mean Difference (IV, Random, 95% CI)

‐0.92 [‐7.59, 5.76]

5.15 Proteinuria at end of study Show forest plot

9

536

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.78, 0.31]

5.15.1 CKD stages 3‐5

9

536

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.78, 0.31]

5.16 Change in proteinuria Show forest plot

8

468

Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.11, 0.09]

5.16.1 CKD stages 3‐5

8

468

Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.11, 0.09]

5.17 Albuminuria at end of study Show forest plot

3

302

Mean Difference (IV, Random, 95% CI)

99.92 [‐10.95, 210.78]

5.17.1 CKD stages 3‐5

3

302

Mean Difference (IV, Random, 95% CI)

99.92 [‐10.95, 210.78]

5.18 Change in albuminuria Show forest plot

3

302

Mean Difference (IV, Random, 95% CI)

‐111.27 [‐280.30, 57.75]

5.18.1 CKD stages 3‐5

3

302

Mean Difference (IV, Random, 95% CI)

‐111.27 [‐280.30, 57.75]

5.19 Graft loss Show forest plot

10

991

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.20]

5.19.1 Kidney transplant

10

991

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.68, 1.20]

5.20 Graft failure Show forest plot

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

5.20.1 Kidney transplant

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

5.21 Delayed graft function Show forest plot

9

713

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.75, 1.10]

5.21.1 Kidney transplant

9

713

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.75, 1.10]

5.22 Malignancy Show forest plot

2

311

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.06, 1.73]

5.22.1 CKD stages 3‐5

1

227

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.05, 2.33]

5.22.2 CKD stage 5D

1

84

Risk Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 7.59]

5.23 Major bleeding Show forest plot

4

211

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.27, 4.48]

5.23.1 CKD stages 3‐5

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.07, 5.97]

5.23.2 CKD stage 5D

2

115

Risk Ratio (M‐H, Random, 95% CI)

3.05 [0.33, 28.45]

5.24 Infection Show forest plot

9

3091

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.92, 1.62]

5.24.1 CKD stages 3‐5

5

2741

Risk Ratio (M‐H, Random, 95% CI)

1.46 [1.28, 1.66]

5.24.2 CKD stages 5D

1

71

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.07, 15.81]

5.24.3 Kidney transplant

3

279

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.78, 1.29]

Figuras y tablas -
Comparison 5. Non‐vitamin antioxidants versus placebo or standard therapy
Comparison 6. Antioxidants versus placebo or standard therapy: low risk of bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Cardiovascular death Show forest plot

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.27, 1.21]

6.1.1 CKD stage 5D

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.27, 1.21]

6.2 Death (any cause) Show forest plot

16

1592

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.66, 1.33]

6.2.1 CKD stages 3‐5

4

498

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.11, 3.69]

6.2.2 CKD stage 5D

10

970

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.69, 1.44]

6.2.3 Kidney transplant

2

124

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.11, 1.95]

6.3 Cardiovascular disease Show forest plot

6

808

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.40, 0.91]

6.3.1 CKD stages 3‐5

4

685

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.40, 0.92]

6.3.2 CKD stage 5D

2

123

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.04, 6.49]

6.4 Coronary heart disease Show forest plot

6

818

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.21, 0.77]

6.4.1 CKD stages 3‐5

4

513

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.24, 1.59]

6.4.2 CKD stage 5D

3

305

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.11, 0.67]

6.5 Heart failure Show forest plot

3

435

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.39, 2.86]

6.5.1 CKD stages 3‐5

3

435

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.39, 2.86]

6.6 Cerebrovascular disease Show forest plot

2

289

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.26, 2.25]

6.6.1 CKD stages 3‐5

1

93

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.81]

6.6.2 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.27, 2.70]

6.7 Peripheral vascular disease Show forest plot

2

365

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.11, 1.15]

6.7.1 CKD stages 3‐5

1

169

Risk Ratio (M‐H, Random, 95% CI)

0.21 [0.01, 4.35]

6.7.2 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.10, 1.40]

6.8 Kidney failure Show forest plot

4

529

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.39, 2.37]

6.8.1 CKD stages 3‐5

4

529

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.39, 2.37]

6.9 eGFR at end of study Show forest plot

11

831

Mean Difference (IV, Random, 95% CI)

3.24 [0.25, 6.22]

6.9.1 CKD stages 3‐5

8

659

Mean Difference (IV, Random, 95% CI)

3.34 [‐0.10, 6.77]

6.9.3 Kidney transplant

3

172

Mean Difference (IV, Random, 95% CI)

1.69 [0.05, 3.33]

6.10 Change in eGFR Show forest plot

9

729

Mean Difference (IV, Random, 95% CI)

3.46 [2.32, 4.60]

6.10.1 CKD stages 3‐5

9

729

Mean Difference (IV, Random, 95% CI)

3.46 [2.32, 4.60]

6.11 Serum creatinine at end of study Show forest plot

4

240

Mean Difference (IV, Random, 95% CI)

‐1.98 [‐11.27, 7.32]

6.11.1 CKD stages 3‐5

2

104

Mean Difference (IV, Random, 95% CI)

‐1.61 [‐13.12, 9.89]

6.11.3 Kidney transplant

2

136

Mean Difference (IV, Random, 95% CI)

‐14.96 [‐61.72, 31.80]

6.12 Change in serum creatinine Show forest plot

4

401

Mean Difference (IV, Random, 95% CI)

‐35.01 [‐68.93, ‐1.09]

6.12.1 CKD stages 3‐5

3

327

Mean Difference (IV, Random, 95% CI)

‐18.84 [‐47.75, 10.08]

6.12.3 Kidney transplant

1

74

Mean Difference (IV, Random, 95% CI)

‐97.00 [‐137.94, ‐56.06]

6.13 Urinary albumin/creatinine ratio at end of study Show forest plot

2

78

Mean Difference (IV, Random, 95% CI)

‐111.94 [‐188.36, ‐35.53]

6.13.1 CKD stages 3‐5

2

78

Mean Difference (IV, Random, 95% CI)

‐111.94 [‐188.36, ‐35.53]

6.14 Change in urinary albumin/creatinine ratio Show forest plot

3

115

Mean Difference (IV, Random, 95% CI)

‐37.54 [‐101.00, 25.92]

6.14.1 CKD stages 3‐5

3

115

Mean Difference (IV, Random, 95% CI)

‐37.54 [‐101.00, 25.92]

6.15 Proteinuria at end of study Show forest plot

3

132

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.00, 0.39]

6.15.1 CKD stages 3‐5

3

132

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.00, 0.39]

6.16 Change in proteinuria Show forest plot

3

132

Mean Difference (IV, Random, 95% CI)

‐0.90 [‐1.80, 0.01]

6.16.1 CKD stages 3‐5

3

132

Mean Difference (IV, Random, 95% CI)

‐0.90 [‐1.80, 0.01]

6.17 Albuminuria at end of study Show forest plot

2

262

Mean Difference (IV, Random, 95% CI)

‐40.57 [‐274.19, 193.04]

6.17.1 CKD stages 3‐5

2

262

Mean Difference (IV, Random, 95% CI)

‐40.57 [‐274.19, 193.04]

6.18 Change in albuminuria Show forest plot

2

262

Mean Difference (IV, Random, 95% CI)

‐172.03 [‐505.20, 161.15]

6.18.1 CKD stages 3‐5

2

262

Mean Difference (IV, Random, 95% CI)

‐172.03 [‐505.20, 161.15]

6.19 Vascular access thrombosis Show forest plot

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

6.19.1 CKD stage 5D

3

209

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.41, 2.84]

6.20 Graft loss Show forest plot

3

198

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.19, 2.30]

6.20.1 Kidney transplant

3

198

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.19, 2.30]

6.21 Delayed graft function Show forest plot

3

172

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.77, 1.54]

6.21.1 Kidney transplant

3

172

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.77, 1.54]

6.22 Malignancy Show forest plot

2

423

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.07, 15.39]

6.22.1 CKD stages 3‐5

1

227

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.05, 2.33]

6.22.2 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

5.10 [0.25, 104.92]

6.23 Major bleeding Show forest plot

3

288

Risk Ratio (M‐H, Random, 95% CI)

1.22 [0.18, 8.34]

6.23.1 CKD stages 3‐5

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.03, 2.40]

6.23.2 CKD stage 5D

2

248

Risk Ratio (M‐H, Random, 95% CI)

3.96 [0.45, 35.12]

6.24 Infection Show forest plot

5

728

Risk Ratio (M‐H, Random, 95% CI)

1.32 [0.70, 2.48]

6.24.1 CKD stages 3‐5

3

436

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.48, 3.40]

6.24.2 CKD stage 5D

2

292

Risk Ratio (M‐H, Random, 95% CI)

1.35 [0.59, 3.09]

Figuras y tablas -
Comparison 6. Antioxidants versus placebo or standard therapy: low risk of bias
Comparison 7. Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Cardiovascular death Show forest plot

6

3633

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.57, 1.36]

7.1.1 CKD stages 3‐5

3

3269

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.46, 1.74]

7.1.2 CKD stages 5D

3

364

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.42, 1.46]

7.2 Death (any cause) Show forest plot

23

5866

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.83, 1.14]

7.2.1 CKD stages 3‐5

8

3860

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.82, 1.20]

7.2.2 CKD stage 5D

7

1151

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.74, 1.39]

7.2.3 Kidney transplant

8

855

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.51, 1.28]

7.3 Cardiovascular disease Show forest plot

12

4446

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 0.98]

7.3.1 CKD stages 3‐5

7

3997

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.57, 1.00]

7.3.2 CKD stage 5D

4

388

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.33, 2.03]

7.3.3 Kidney transplant

1

61

Risk Ratio (M‐H, Random, 95% CI)

Not estimable

7.4 Coronary heart disease Show forest plot

9

4073

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.57, 1.13]

7.4.1 CKD stages 3‐5

5

3667

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.75, 1.24]

7.4.2 CKD stage 5D

4

406

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.25, 1.22]

7.5 Heart failure Show forest plot

5

3613

Risk Ratio (M‐H, Random, 95% CI)

1.40 [1.11, 1.76]

7.5.1 CKD stages 3‐5

5

3613

Risk Ratio (M‐H, Random, 95% CI)

1.40 [1.11, 1.76]

7.6 Cerebrovascular disease Show forest plot

6

1588

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.69, 1.29]

7.6.1 CKD stages 3‐5

3

1147

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.71, 1.38]

7.6.2 CKD stage 5D

3

441

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.25, 2.02]

7.7 Peripheral vascular disease Show forest plot

4

1492

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.41, 1.47]

7.7.1 CKD stages 3‐5

2

1162

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.34, 2.90]

7.7.2 CKD stage 5D

2

330

Risk Ratio (M‐H, Random, 95% CI)

0.54 [0.26, 1.12]

7.8 Kidney failure Show forest plot

9

3117

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.53, 1.09]

7.8.1 CKD stages 3‐5

8

2940

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.55, 1.25]

7.8.2 Kidney transplant

1

177

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.26, 1.11]

7.9 eGFR at end of study Show forest plot

20

1751

Mean Difference (IV, Random, 95% CI)

3.48 [1.09, 5.87]

7.9.1 CKD stages 3‐5

15

1239

Mean Difference (IV, Random, 95% CI)

3.42 [0.83, 6.01]

7.9.2 Kidney transplant

5

512

Mean Difference (IV, Random, 95% CI)

2.16 [‐10.20, 14.52]

7.10 Change in eGFR Show forest plot

18

3496

Mean Difference (IV, Random, 95% CI)

3.71 [2.77, 4.65]

7.10.1 CKD stages 3‐5

16

3425

Mean Difference (IV, Random, 95% CI)

3.82 [2.85, 4.78]

7.10.2 Kidney transplant

2

71

Mean Difference (IV, Random, 95% CI)

3.97 [‐4.18, 12.13]

7.11 Serum creatinine at end of study Show forest plot

11

1027

Mean Difference (IV, Random, 95% CI)

‐6.11 [‐21.23, 9.01]

7.11.1 CKD stages 3‐5

4

326

Mean Difference (IV, Random, 95% CI)

‐6.27 [‐32.00, 19.46]

7.11.2 Kidney transplant

7

701

Mean Difference (IV, Random, 95% CI)

‐5.86 [‐24.78, 13.07]

7.12 Change in serum creatinine Show forest plot

9

2847

Mean Difference (IV, Random, 95% CI)

‐16.21 [‐26.43, ‐6.00]

7.12.1 CKD stages 3‐5

6

2734

Mean Difference (IV, Random, 95% CI)

‐27.38 [‐37.80, ‐16.96]

7.12.2 Kidney transplant

3

113

Mean Difference (IV, Random, 95% CI)

7.86 [‐2.78, 18.50]

7.13 Urinary albumin/creatinine ratio at end of study Show forest plot

3

1119

Mean Difference (IV, Random, 95% CI)

‐2.63 [‐29.36, 24.11]

7.13.1 CKD stages 3‐5

3

1119

Mean Difference (IV, Random, 95% CI)

‐2.63 [‐29.36, 24.11]

7.14 Change in urinary albumin/creatinine ratio Show forest plot

3

1086

Mean Difference (IV, Random, 95% CI)

0.35 [‐16.76, 17.45]

7.14.1 CKD stages 3‐5

3

1086

Mean Difference (IV, Random, 95% CI)

0.35 [‐16.76, 17.45]

7.15 Proteinuria at end of study Show forest plot

5

233

Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.88, ‐0.02]

7.15.1 CKD stages 3‐5

5

233

Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.88, ‐0.02]

7.16 Change in proteinuria Show forest plot

4

209

Mean Difference (IV, Random, 95% CI)

‐1.65 [‐3.26, ‐0.03]

7.16.1 CKD stages 3‐5

4

209

Mean Difference (IV, Random, 95% CI)

‐1.65 [‐3.26, ‐0.03]

7.17 Albuminuria at end of study Show forest plot

3

353

Mean Difference (IV, Random, 95% CI)

‐2.78 [‐151.55, 145.99]

7.17.1 CKD stages 3‐5

3

353

Mean Difference (IV, Random, 95% CI)

‐2.78 [‐151.55, 145.99]

7.18 Change in albuminuria Show forest plot

3

353

Mean Difference (IV, Random, 95% CI)

‐88.37 [‐319.83, 143.09]

7.18.1 CKD stages 3‐5

3

353

Mean Difference (IV, Random, 95% CI)

‐88.37 [‐319.83, 143.09]

7.19 Vascular access thrombosis Show forest plot

1

34

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.28, 1.81]

7.19.1 CKD stage 5D

1

34

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.28, 1.81]

7.20 Graft loss Show forest plot

7

794

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.66, 1.16]

7.20.1 Kidney transplant

7

794

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.66, 1.16]

7.21 Graft failure Show forest plot

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

7.21.1 Kidney transplant

1

61

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.06, 12.95]

7.22 Delayed graft function Show forest plot

5

571

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.69, 1.07]

7.22.1 Kidney transplant

5

571

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.69, 1.07]

7.23 Malignancy Show forest plot

2

423

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.07, 15.39]

7.23.1 CKD stages 3‐5

1

227

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.05, 2.33]

7.23.2 CKD stage 5D

1

196

Risk Ratio (M‐H, Random, 95% CI)

5.10 [0.25, 104.92]

7.24 Major bleeding Show forest plot

5

397

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.35, 2.95]

7.24.1 CKD stages 3‐5

2

96

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.07, 5.97]

7.24.2 CKD stages 5D

3

301

Risk Ratio (M‐H, Random, 95% CI)

1.38 [0.36, 5.24]

7.25 Infection Show forest plot

9

3268

Risk Ratio (M‐H, Random, 95% CI)

1.45 [1.28, 1.65]

7.25.1 CKD stages 3‐5

5

2682

Risk Ratio (M‐H, Random, 95% CI)

1.46 [1.28, 1.67]

7.25.2 CKD stage 5D

3

449

Risk Ratio (M‐H, Random, 95% CI)

1.38 [0.69, 2.74]

7.25.3 Kidney transplant

1

137

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.45, 2.70]

Figuras y tablas -
Comparison 7. Antioxidants versus placebo or standard therapy: follow‐up for 6 months or more