As seen in Figure 1, five RCTs involving 263 patients reported Ccr, the meta-analysis showed that the Ccr level was significantly higher in the groups receiving calcium disodium EDTA as compared with the groups receiving placebo (SMD,

0.68; 95% CI, 0.43 to 0.93; P < 0.00001). These results suggest that calcium disodium EDTA chelation therapy has a significant benefit of retarding the progression MK-1775 cell line of chronic kidney disease in patients with measurable body lead burdens. However, the pooled estimate showed that the calcium disodium EDTA treatment group did not have a significant decrease in urine protein level compared with that of the control group (SMD, −0.17; 95% CI, −0.46 to 0.11; P = 0.24, Fig. 1). The first reported case of nephrotoxicity associated with lead was described more than a hundred years ago. From then on, exposure to lead has been thought of as a risk factor for kidney injury. Because blood lead levels indicate only recent exposure to lead, see more the level of body lead burden is considered as a more accurate indicator

reflecting the lead load in the human body, and urinary lead excretion <600 μg/72 h after calcium disodium EDTA chelation therapy is considered as a normal body lead burden. However, it was found that lead has a direct toxic effect on the kidney even at ‘normal or acceptable’ levels.[2, 3] The pathogenesis of nephrotoxic effects of lead is mainly related to direct toxicity, inflammation and oxidative stress.[2,

13, 14] A growing body of research has shown that lead exposure is a reversible risk factor for CKD progression,[4-9] nonetheless, the optimal strategy to treat lead nephrotoxicity remains uncertain. Chelating agents such as calcium disodium EDTA are widely used to remove toxic metals, and this therapy could exert long-term antioxidant, anti-inflammatory effects.[15] However, lead chelation is controversial owing to the potential of its use in lieu of exposure reduction. In addition, cases of acute tubular necrosis have been reported following early clinical use of calcium disodium EDTA that involved very large doses.[16] Fortunately, adverse renal effects have not been observed Evodiamine at low levels of exposure such as in the trials included in our meta-analysis. The main finding of the current meta-analysis is that calcium disodium EDTA chelation therapy could effectively delay the progression of chronic kidney disease among patients with measurable body lead burdens by increasing the levels of GFR and Ccr. There is no conclusive evidence that chelation therapy with calcium disodium EDTA reduces proteinuria. However, our findings indicate the need to be confirmed by more larger randomized clinical trials. There are several important potential study limitations to this meta-analysis. First, most of the included studies were small-scale studies that may have had patient selection and treatment bias. Second, most studies were not blinded.