Association between Soluble Urokinase-Type Plasminogen Activator Receptor Levels and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background. Chronic kidney disease (CKD) has become a global public health problem with a high prevalence and mortality. There is no sensitive and effective markers for chronic kidney disease. Previous studies proposed suPAR as an early predict biomarker for chronic kidney disease, but the results are controversial. Therefore, the purpose of the current meta-analysis is to evaluate the association between suPAR and CKD. Methods. We searched the PubMed, Embase, Cochrane Library databases, and Web of Science before May 1, 2019. The search was based on the key words including suPAR and CKD. Data are extracted independently according to standard format, and quality analysis is performed. We extracted the concentration of suPAR and hazard rate (HR) values of mortality, cardiovascular disease, and end-stage renal disease. Results. There were 14 studies fulfilling the criteria. The concentration of suPAR was higher in patients with CKD than that in the control group (P<0.001; SMD: -2.17; 95% CI: -2.71, -1.63; I-2 = 67.4%). SuPAR had a higher risk of mortality (P=0.001; HR: 1.72; 95% CI: 1.24, 2.39; I-2 = 68.0%). The higher suPAR level increased the risk of cardiovascular disease (P<0.001; HR: 3.06; 95% CI: 2.21, 4.22; I-2 = 0.0%) and the risk of end-stage renal disease (P<0.001; HR: 1.40; 95% CI: 1.22, 1.60; I-2 = 0.0%). Conclusions. Monitoring suPAR concentrations may be used for early diagnosis and prognosis for patients with CKD, and the higher suPAR increased the risk of mortality, cardiovascular events, and end-stage renal disease.