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Encore une étude observationnelle par l’équipe de Block et coll. sur 5’976 patients en hémodialyse recevant de la vitamine D IV et un traitement de cinacalcet. La prise de cinacalcet montre un bénéfice significatif sur la mortalité après avoir pris en compte tous les facteurs confondants.
Hormis le faite que la statistique est une belle science et permet de faire de beau tableau, je trouve qu’une remarque dans la discussion vaut la peine d’être relevée et résume bien la situation actuelle.
However, it is imperative to note that no randomized clinical trial has shown that reduced levels of these minerals are associated with improved clinical outcome. Despite the compelling nature of our results, these data most strongly support the ongoing EVOLVE trial. Nephrology is currently mired in a unfortunate situation, in which observational data are used to generate clinical treatment guidelines rather than hypothese to be tested with randomized controlled clinical trials. Such an approach has offer proved to be erroneous when ultimately tested in properly conducted clinical trials. Remarkably, some members of the community go so far as to suggest that, on the basis of observational data alone, conducting randomized controlled trials is precluded on ethical grouds. We must resisting adopting this approach.
Attendons les résultats d’EVOLVE pour conclure ou se poser d’autres questions…
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