KDIGO 2025框架下IgA肾病中医药证据与治疗定位
Traditional Chinese Medicine for IgA Nephropathy under the KDIGO 2025 Framework: Evidence and Therapeutic Positioning
DOI: 10.12677/tcm.2026.1511646, PDF,   
作者: 杨玉统, 秦 曼*：黑龙江省中医药科学院研究生院，黑龙江 哈尔滨
关键词: IgA肾病；KDIGO 2025；中医药；辅助治疗；循证医学；IgA Nephropathy； KDIGO 2025； Traditional Chinese Medicine； Adjunctive Therapy； Evidence-Based Medicine
摘要: 目的：在KDIGO 2025治疗框架下综述中医药治疗IgA肾病(IgAN)的临床证据、可能机制、安全性及治疗定位，区分短期替代终点与长期肾脏结局。方法：采用证据导向的叙述性综述，围绕现代支持治疗、中医药临床证据、机制证据和安全性组织资料，并按随机附加治疗、活性对照、非随机比较和系统综述分层。结果：部分标准化制剂、复方或中西医结合方案在规范支持治疗基础上可降低短期蛋白尿，但背景治疗、制剂、剂量、对照和结局差异较大，长期eGFR及肾衰竭获益尚未证实。机制研究多来自动物、细胞、网络药理学和分子对接，不能证明人体因果疗效；产品质量、毒性和药物相互作用资料也不充分。结论：中医药宜作为规范治疗基础上的潜在辅助或探索性干预，不能替代具有明确适应证的循证治疗；未来需标准化制剂、一致背景治疗、长期随机附加试验和系统安全监测。
Abstract: Objective: To review the clinical evidence, possible mechanisms, safety, and therapeutic positioning of traditional Chinese medicine (TCM) for IgA nephropathy (IgAN) within the KDIGO 2025 treatment framework, distinguishing short-term surrogate outcomes from long-term kidney outcomes. Methods: An evidence-oriented narrative review was conducted around contemporary supportive care, clinical evidence for TCM, mechanistic evidence, and safety, with studies grouped as randomized add-on trials, active-comparator studies, non-randomized comparisons, and systematic reviews. Results: Some standardized products, compound formulas, or integrated Chinese and Western medicine regimens may reduce short-term proteinuria when added to standard supportive care. However, background treatment, products, doses, comparators, and outcome definitions vary substantially, and benefits for long-term eGFR or kidney failure have not been established. Mechanistic evidence is derived mainly from animal, cellular, network-pharmacology, and molecular-docking studies and cannot establish causal benefit in humans. Information on product quality, toxicity, and herb-drug interactions is also incomplete. Conclusions: TCM should be regarded as a potential adjunctive or exploratory intervention on top of standard supportive care. It should not replace evidence-based treatments with established indications. Future studies require standardized products, consistent background therapy, long-term randomized add-on trials, and systematic safety monitoring.
文章引用：杨玉统, 秦曼. KDIGO 2025框架下IgA肾病中医药证据与治疗定位[J]. 中医学, 2026, 15(11): 233-243. https://doi.org/10.12677/tcm.2026.1511646

参考文献

[1] Rovin, B.H., Barratt, J., Cook, H.T., Noronha, I.L., Reich, H.N., Suzuki, Y., et al. (2025) KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin a Vasculitis (IgAV). Kidney International, 108, S1-S71.
https://doi.org/10.1016/j.kint.2025.04.004
[2] Floege, J., Barratt, J., Cook, H.T., Noronha, I.L., Reich, H.N., Suzuki, Y., et al. (2025) Executive Summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin a Vasculitis (IgAV). Kidney International, 108, 548-554.
https://doi.org/10.1016/j.kint.2025.04.003
[3] Stamellou, E., Seikrit, C., Tang, S.C.W., Boor, P., Tesař, V., Floege, J., et al. (2023) IgA Nephropathy. Nature Reviews Disease Primers, 9, Article No. 67.
https://doi.org/10.1038/s41572-023-00476-9
[4] Pitcher, D., Braddon, F., Hendry, B., Mercer, A., Osmaston, K., Saleem, M.A., et al. (2023) Long-Term Outcomes in IgA Nephropathy. Clinical Journal of the American Society of Nephrology, 18, 727-738.
https://doi.org/10.2215/cjn.0000000000000135
[5] Tunnicliffe, D.J., Reid, S., Craig, J.C., Samuels, J.A., Molony, D.A. and Strippoli, G.F. (2024) Non-Immunosuppressive Treatment for IgA Nephropathy. Cochrane Database of Systematic Reviews, 2024, CD003962.
https://doi.org/10.1002/14651858.cd003962.pub3
[6] Lafayette, R., Kristensen, J., Stone, A., Floege, J., Tesař, V., Trimarchi, H., et al. (2023) Efficacy and Safety of a Targeted-Release Formulation of Budesonide in Patients with Primary IgA Nephropathy (NefIgArd): 2-Year Results from a Randomised Phase 3 Trial. The Lancet, 402, 859-870.
https://doi.org/10.1016/s0140-6736(23)01554-4
[7] Rovin, B.H., Barratt, J., Heerspink, H.J.L., Alpers, C.E., Bieler, S., Chae, D., et al. (2023) Efficacy and Safety of Sparsentan versus Irbesartan in Patients with IgA Nephropathy (PROTECT): 2-Year Results from a Randomised, Active-Controlled, Phase 3 Trial. The Lancet, 402, 2077-2090.
https://doi.org/10.1016/s0140-6736(23)02302-4
[8] Lv, J., Wong, M.G., Hladunewich, M.A., Jha, V., Hooi, L.S., Monaghan, H., et al. (2022) Effect of Oral Methylprednisolone on Decline in Kidney Function or Kidney Failure in Patients with IgA Nephropathy: The TESTING Randomized Clinical Trial. Journal of the American Medical Association, 327, 1888-1898.
https://doi.org/10.1001/jama.2022.5368
[9] Hou, F.F., Xie, D., Wang, J., Xu, X., Yang, X., Ai, J., et al. (2023) Effectiveness of Mycophenolate Mofetil among Patients with Progressive IgA Nephropathy. JAMA Network Open, 6, e2254054.
https://doi.org/10.1001/jamanetworkopen.2022.54054
[10] EMPA-KIDNEY Collaborative Group (2024) Impact of Primary Kidney Disease on the Effects of Empagliflozin in Patients with Chronic Kidney Disease: Secondary Analyses of the EMPA-KIDNEY Trial. The Lancet Diabetes & Endocrinology, 12, 51-60.
[11] Heerspink, H.J.L., Jardine, M., Kohan, D.E., Lafayette, R.A., Levin, A., Liew, A., et al. (2025) Atrasentan in Patients with IgA Nephropathy. New England Journal of Medicine, 392, 544-554.
https://doi.org/10.1056/nejmoa2409415
[12] Perkovic, V., Barratt, J., Rovin, B., Kashihara, N., Maes, B., Zhang, H., et al. (2025) Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy. New England Journal of Medicine, 392, 531-543.
https://doi.org/10.1056/nejmoa2410316
[13] Mathur, M., Barratt, J., Chacko, B., Chan, T.M., Kooienga, L., Oh, K., et al. (2024) A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy. New England Journal of Medicine, 390, 20-31.
https://doi.org/10.1056/nejmoa2305635
[14] Zhang, H., Rizk, D.V., Perkovic, V., Maes, B., Kashihara, N., Rovin, B., et al. (2024) Results of a Randomized Double-Blind Placebo-Controlled Phase 2 Study Propose Iptacopan as an Alternative Complement Pathway Inhibitor for IgA Nephropathy. Kidney International, 105, 189-199.
https://doi.org/10.1016/j.kint.2023.09.027
[15] Perkovic, V., Trimarchi, H., Tesar, V., Lafayette, R., Wong, M.G., Barratt, J., et al. (2026) Sibeprenlimab in IgA Nephropathy—Interim Analysis of a Phase 3 Trial. New England Journal of Medicine, 394, 635-646.
https://doi.org/10.1056/nejmoa2512133
[16] Wheeler, D.C., Toto, R.D., Stefánsson, B.V., Jongs, N., Chertow, G.M., Greene, T., et al. (2021) A Pre-Specified Analysis of the DAPA-CKD Trial Demonstrates the Effects of Dapagliflozin on Major Adverse Kidney Events in Patients with IgA Nephropathy. Kidney International, 100, 215-224.
https://doi.org/10.1016/j.kint.2021.03.033
[17] Chen, Y., Tang, J., Li, X., Zhang, X., Zhang, F., Zheng, R., et al. (2026) Yi-Shen-Hua-Shi Granule Added to Supportive Care Reduces Proteinuria in IgA Nephropathy: A Multicenter Randomized Controlled Trial. Renal Failure, 48, Article 2646430.
https://doi.org/10.1080/0886022x.2026.2646430
[18] Li, P., Lin, H., Ni, Z., Zhan, Y., He, Y., Yang, H., et al. (2020) Efficacy and Safety of Abelmoschus Manihot for IgA Nephropathy: A Multicenter Randomized Clinical Trial. Phytomedicine, 76, Article 153231.
https://doi.org/10.1016/j.phymed.2020.153231
[19] Wang, X.H., Lang, R., Liang, Y., Zeng, Q., Chen, N. and Yu, R.H. (2021) Traditional Chinese Medicine in Treating IgA Nephropathy: From Basic Science to Clinical Research. Journal of Translational Internal Medicine, 9, 161-167.
https://doi.org/10.2478/jtim-2021-0021
[20] Chinese Association of Integrative Medicine, China Association of Chinese Medicine and Chinese Medical Association (2023) Guidelines for Diagnosis and Management of Immunoglobulin A Nephropathy with Integrated Traditional Chinese and Western Medicine. (In Chinese)
http://files.sciconf.cn/upload/tinymce/20230607/20230607092946_79394.pdf
[21] Pan, Z., Zhao, M., Chang, M., Shi, X., Ma, S. and Zhang, Y. (2023) Clinical Efficacy of Supplementing Qi Dispelling Wind and Activating Blood Circulation Method in the Treatment of IgA Nephropathy: A Meta-Analysis. Medicine, 102, e33123.
https://doi.org/10.1097/md.0000000000033123
[22] Chen, X.M., Chen, Y.P. and Chen, J. (2007) Multicentered, Randomized, Controlled Clinical Trial on Patients with IgA Nephropathy of Qi-Yin Deficiency Syndrome Type. Chinese Journal of Integrated Traditional and Western Medicine, 27, 101-105. (In Chinese)
[23] Wei, M., Xiong, P. and Zhang, L. (2013) Effect of Chinese Herbs on Immunoglobulin A Nephropathy: A Randomized Controlled Trial. Journal of Traditional Chinese Medicine, 33, 65-69.
https://doi.org/10.1016/s0254-6272(13)60102-8
[24] Yang, Y., Li, X., Zou, H., Li, M., Wang, L., Luo, K., et al. (2025) Efficacy and Safety of Kunxian in IgA Nephropathy. Frontiers in Pharmacology, 16, Article 1496967.
https://doi.org/10.3389/fphar.2025.1496967
[25] Le, W.B., Shi, J.S., Gong, S.W. and Yang, F. (2022) Effectiveness and Safety of Kunxian Capsule for the Treatment of IgA Nephropathy. BMC Nephrology, 23, Article No. 179.
https://doi.org/10.1186/s12882-022-02814-7
[26] Li, L.T., Shi, M.Y., Wei, S.Y., Li, T. and Li, B. (2013) Huai Qi Huang Ameliorates Proteinuria and Hematuria in Mild IgA Nephropathy Patients: A Prospective Randomized Controlled Study. JFMA, 112, 766-772.
https://doi.org/10.1016/j.jfma.2013.10.019
[27] Zheng, L., Gu, X., Zhang, L., Yang, C., Sun, X., Zhang, W., et al. (2026) Which Commercial Chinese Polyherbal Preparations Combined with ACEI/ARB Is Effective and Safe for IgA Nephropathy? A Systematic Review and Network Meta-Analysis. Frontiers in Pharmacology, 17, Article 1755995.
https://doi.org/10.3389/fphar.2026.1755995
[28] Thompson, A., Carroll, K., A. Inker, L., Floege, J., Perkovic, V., Boyer-Suavet, S., et al. (2019) Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clinical Journal of the American Society of Nephrology, 14, 469-481.
https://doi.org/10.2215/cjn.08600718
[29] Ru, Y., Luo, Y., Zhou, Y., Kuai, L., Sun, X., Xing, M., et al. (2019) Adverse Events Associated with Treatment of Tripterygium Wilfordii Hook F: A Quantitative Evidence Synthesis. Frontiers in Pharmacology, 10, Article 1250.
https://doi.org/10.3389/fphar.2019.01250
[30] Li, M., Wang, Y., Chen, Y., Dong, L., Liu, J., Dong, Y., et al. (2024) A Comprehensive Review on Pharmacokinetic Mechanism of Herb-Herb/Drug Interactions in Chinese Herbal Formula. Pharmacology & Therapeutics, 264, Article 108728.
https://doi.org/10.1016/j.pharmthera.2024.108728
[31] Choudhury, A., Singh, P.A., Bajwa, N., Dash, S. and Bisht, P. (2023) Pharmacovigilance of Herbal Medicines: Concerns and Future Prospects. Journal of Ethnopharmacology, 309, Article 116383.
https://doi.org/10.1016/j.jep.2023.116383
[32] Chen, Y., Cai, Y.Y., Yu, H.K. and Zou, C. (2023) Professor Huang Chunlin’s Experience in Treating IgA Nephropathy with the Theory of Correlation between the Five Viscera. Journal of Nanjing University of Traditional Chinese Medicine, 39, 1049-1053. (In Chinese)
[33] Wang, X., Sun, X., Xin, C., et al. (2025) Syndrome Differentiation and Staged Treatment of IgA Nephropathy from the Perspective of Regulating Sanjiao and Restoring Pleurodiaphragmatic Interspace Permeability Based on the Theory of Latent Pathogens. Beijing Journal of Traditional Chinese Medicine, 44, 1341-1346. (In Chinese)
[34] Gu, Y., Wang, Y., Ji, C., Fan, P., He, Z., Wang, T., et al. (2017) Syndrome Differentiation of IgA Nephropathy Based on Clinicopathological Parameters: A Decision Tree Model. Evidence-Based Complementary and Alternative Medicine, 2017, Article 2697560.
https://doi.org/10.1155/2017/2697560
[35] Li, J.J., Chen, X.M. and Wei, R.B. (2013) Potential of Renal Pathology on Refining Syndrome Typing of Chinese Medicine in IgA Nephropathy. Chinese Journal of Integrative Medicine, 19, 92-97.
https://doi.org/10.1007/s11655-012-1214-8
[36] Ke, J., Duan, S., Liu, L., Yin, Z., Li, S., Ke, Y., et al. (2022) Relationship between Traditional Chinese Medicine Syndrome Elements and Prognosis of Patients with IgA Nephropathy. Evidence-Based Complementary and Alternative Medicine, 2022, 1-10.
https://doi.org/10.1155/2022/2270406
[37] Liu, L., Yin, Z., Ma, J., Duan, S. and Chen, X. (2019) Potential Association of Body Constitution with the Prognosis of IgA Nephropathy: A Long-Time Follow-Up of 203 Cases in China. Evidence-Based Complementary and Alternative Medicine, 2019, 1-6.
https://doi.org/10.1155/2019/6289478
[38] Yu, W.Y., Shi, N.N., Wang, L.Y., Xie, Y.M., Han, X.J. and Lu, A.P. (2012) Development of Clinical Practice Guidelines in 11 Common Diseases with Chinese Medicine Interventions in China. Chinese Journal of Integrative Medicine, 18, 112-119.
https://doi.org/10.1007/s11655-012-0997-y
[39] Chen, H.Y., Zheng, X.Y., Wang, Z., Ding, X.Y., et al. (2025) A Prognostic Model of Immunoglobulin A Nephropathy Using Artificial Neural Network: A Retrospective Study Based on Integrated Chinese and Western Medicine. Journal of Traditional Chinese Medicine, 45, 676-684.
[40] Shi, X., Zhou, N., Zhou, C. and Shen, Y. (2012) Clinical and Pathological Analysis on Traditional Chinese Medicine Syndromes in Children with Immunoglobulin A Nephropathy. Journal of Traditional Chinese Medicine, 32, 358-363.
https://doi.org/10.1016/s0254-6272(13)60038-2
[41] Zhong, Y.F., Chen, Y.P., Deng, Y.Y., Chen, N. and Wang, Z.H. (2008) Correlation between Traditional Chinese Medicine Syndromes in Primary Immunoglobulin A Nephropathy and A267G in 5’-Untranslated Region within Exonal of Megsin Gene. Journal of Chinese Integrative Medicine, 6, 463-467.
https://doi.org/10.3736/jcim20080506
[42] Wang, Z., Yu, C., Zhou, L.N. and Chen, X. (2017) Effects of Tripterygium wilfordii Induction Therapy to IgA Nephropathy Patients with Heavy Proteinuria. Biological & Pharmaceutical Bulletin, 40, 1833-1838.
https://doi.org/10.1248/bpb.b17-00134
[43] Guan, X.D., Wu, Y.F. and Zhao, W. (2005) Clinical Observation on Treatment of IgA Nephropathy with Huobahuagen Tablets and Irbesartan. Journal of Chinese Integrative Medicine, 3, 366-369.
https://doi.org/10.3736/jcim20050509
[44] Xu, R., Zhang, J., Hu, X., Xu, P., Huang, S., Cui, S., et al. (2024) Yi-Shen-Hua-Shi Granules Modulate Immune and Inflammatory Damage via the ALG3/PPARγ/NF-κB Pathway in the Treatment of Immunoglobulin A Nephropathy. Journal of Ethnopharmacology, 319, Article 117204.
https://doi.org/10.1016/j.jep.2023.117204
[45] Makita, Y. and Reich, H.N. (2024) Pathogenic Immunoglobulin A-Producing Cells in Immunoglobulin A Nephropathy. Journal of Clinical Medicine, 13, Article 5255.
https://doi.org/10.3390/jcm13175255
[46] Matsumoto, Y., Aryal, R.P., Heimburg-Molinaro, J., Park, S.S., Wever, W.J., Lehoux, S., et al. (2022) Identification and Characterization of Circulating Immune Complexes in IgA Nephropathy. Science Advances, 8, eabm8783.
https://doi.org/10.1126/sciadv.abm8783
[47] Mathur, M., Chan, T.M., Oh, K., Kooienga, L., Zhuo, M., Pinto, C.S., et al. (2023) A Proliferation-Inducing Ligand (APRIL) in the Pathogenesis of Immunoglobulin A Nephropathy: A Review of the Evidence. Journal of Clinical Medicine, 12, Article 6927.
https://doi.org/10.3390/jcm12216927
[48] Barratt, J., Lafayette, R.A., Zhang, H., Tesar, V., Rovin, B.H., Tumlin, J.A., et al. (2023) IgA Nephropathy: The Lectin Pathway and Implications for Targeted Therapy. Kidney International, 104, 254-264.
https://doi.org/10.1016/j.kint.2023.04.029
[49] Ma, S., Zhao, M., Chang, M., Shi, X., Shi, Y. and Zhang, Y. (2023) Effects and Mechanisms of Chinese Herbal Medicine on IgA Nephropathy. Phytomedicine, 117, Article 154913.
https://doi.org/10.1016/j.phymed.2023.154913
[50] Wu, Q., Meng, W., Shen, J.J., Bai, J.Y., Wang, L.B., Liang, T.Y., et al. (2022) Guben Tongluo Formula Protects LPS-Induced Damage in Lamina Propria B Lymphocytes through TLR4/MyD88/NF-κB Pathway. Current Medical Science, 42, 991-999.
https://doi.org/10.1007/s11596-022-2622-4
[51] Liang, X., Zhang, S., Zhang, D., Hu, L., Zhang, L., Peng, Y., et al. (2022) Metagenomics-Based Systematic Analysis Reveals That Gut Microbiota Gd-IgA1-Associated Enzymes May Play a Key Role in Iga Nephropathy. Frontiers in Molecular Biosciences, 9, Article 970723.
https://doi.org/10.3389/fmolb.2022.970723
[52] Hua, K.F., Yang, S.M., Kao, T.Y., Chang, J.M., Chen, H.L., Tsai, Y.J., et al. (2013) Osthole Mitigates Progressive IgA Nephropathy by Inhibiting Reactive Oxygen Species Generation and NF-κB/NLRP3 Pathway. PLOS ONE, 8, e77794.
https://doi.org/10.1371/journal.pone.0077794
[53] Liu, W., Shi, L., Wan, Q., Wu, Y., Huang, D., Ou, J., et al. (2021) Huangqi Guizhi Wuwu Decoction Attenuates Podocyte Cytoskeletal Protein Damage in IgA Nephropathy Rats by Regulating AT1R/Nephrin/c-Abl Pathway. Biomedicine & Pharmacotherapy, 142, Article 111907.
https://doi.org/10.1016/j.biopha.2021.111907
[54] Deng, X., Luo, Y., Lu, M., Guan, T., Li, Y. and Guo, X. (2022) Unraveling the Mechanism of Zhibaidihuang Decoction against IgA Nephropathy Using Network Pharmacology and Molecular Docking Analyses. The Tohoku Journal of Experimental Medicine, 259, 37-47.
https://doi.org/10.1620/tjem.2022.j088
[55] Chang, T.Y., Wang, H.A., Wang, Y.P., Ma, J.H., Zou, D., Zhang, S.L., et al. (2022) Efficacy of Traditional Chinese Medicine on Animal Model of IgA Nephropathy: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2022, 1-12.
https://doi.org/10.1155/2022/6106993
[56] Shen, P., Shen, J., Sun, C., Yang, X. and He, L. (2016) A System Biology Approach to Understanding the Molecular Mechanisms of Gubentongluo Decoction Acting on IgA Nephropathy. BMC Complementary and Alternative Medicine, 16, Article No. 312.
https://doi.org/10.1186/s12906-016-1268-9
[57] Cao, J.W., Tang, Y.W., Jiang, M.Y., Lu, M.D., Yang, R.C., Yu, D.R., et al. (2025) Integrative Network Pharmacology and Transcriptomics Reveal the Mechanism of Gui-Qi-Yi-Shen Granules in the Treatment of IgA Nephropathy. Drug Design, Development and Therapy, 19, 6269-6282.
https://doi.org/10.2147/dddt.s526706
[58] Zhang, H., Zhang, Y., Zhang, T. and Liu, C. (2022) Research Progress on Quality Markers of Traditional Chinese Medicine. Journal of Pharmaceutical and Biomedical Analysis, 211, Article 114588.
https://doi.org/10.1016/j.jpba.2022.114588
[59] Hopewell, S., Chan, A.W., Collins, G.S., Hróbjartsson, A., Moher, D., Schulz, K.F., et al. (2025) CONSORT 2025 Statement: Updated Guideline for Reporting Randomised Trials. British Medical Journal, 389, e081123.
https://doi.org/10.1136/bmj-2024-081123
[60] Chan, A.W., Boutron, I., Hopewell, S., Moher, D., Schulz, K.F., Collins, G.S., et al. (2025) SPIRIT 2025 Statement: Updated Guideline for Protocols of Randomized Trials. Journal of the American Medical Association, 334, 435-443.
https://doi.org/10.1001/jama.2025.4486
[61] Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al. (2021) The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. PLOS Medicine, 18, e1003583.
https://doi.org/10.1371/journal.pmed.1003583
[62] Hoffmann, T.C., Glasziou, P.P., Boutron, I., Milne, R., Perera, R., Moher, D., et al. (2014) Better Reporting of Interventions: Template for Intervention Description and Replication (TIDieR) Checklist and Guide. British Medical Journal, 348, g1687.
https://doi.org/10.1136/bmj.g1687
[63] Cheng, C.W., Wu, T.X., Shang, H.C., Li, Y.P., et al. (2017) CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration. Annals of Internal Medicine, 167, 112-121.
https://doi.org/10.7326/m16-2977
[64] Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., et al. (2008) GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations. British Medical Journal, 336, 924-926.
https://doi.org/10.1136/bmj.39489.470347.ad
[65] Fu, E.L. (2023) Target Trial Emulation to Improve Causal Inference from Observational Data: What, Why, and How? Journal of the American Society of Nephrology, 34, 1305-1314.
https://doi.org/10.1681/asn.0000000000000152