Natural Medicines for Acute Renal Failure a Review

Meta-Analysis

. 2019 May i;9(4):e025653.

doi: ten.1136/bmjopen-2018-025653.

Chinese herbal medicine for diabetic kidney illness: a systematic review and meta-assay of randomised placebo-controlled trials

Lihong Yang ^{# 2 3} , Johannah Shergis ^iv , Lei Zhang ¹ , Anthony Lin Zhang ⁴ , Xinfeng Guo ^{ii three} , Xindong Qin ¹ , David Johnson ^{v half dozen} , Xusheng Liu ¹ , Chuanjian Lu ^{two 7} , Charlie Changli Xue ^{# 4} , Wei Mao ^{# one}

Affiliations

• PMID: 31048437
• PMCID: PMC6501976
• DOI: x.1136/bmjopen-2018-025653

Free PMC article

Meta-Analysis

Chinese herbal medicine for diabetic kidney illness: a systematic review and meta-assay of randomised placebo-controlled trials

La Zhang  et al. BMJ Open up. 2019 .

Complimentary PMC article

Abstract

Objectives: To provide a wide evaluation of the efficacy and safety of oral Chinese herbal medicine (CHM) as an adjunctive treatment for diabetic kidney disease (DKD), including mortality, progression to cease-stage kidney disease (ESKD), albuminuria, proteinuria and kidney function.

Blueprint: A systematic review and meta-analysis.

Methods: Randomised controlled trials (RCTs) comparing oral CHM with placebo equally an additional intervention to conventional treatments were retrieved from five English (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Allied and Complementary Medicine Database and Cumulative Index of Nursing and Allied Health Literature) and four Chinese databases (China BioMedical Literature, China National Knowledge Infrastructure, Chonqing VIP and Wanfang) from inception to May 2018. RCTs recruiting adult DKD patients induced by principal diabetes were considered eligible, regardless of the grade and ingredients of oral CHM. Mean difference (MD) or standardised hateful difference (SMD) was used to analyse continuous variables and RR for dichotomous data.

Results: From 7255 reports retrieved, twenty eligible studies involving 2719 DKD patients were included. CHM was associated with greater reduction of albuminuria than placebo, regardless of whether renin-angiotensin arrangement (RAS) inhibitors were concurrently administered (SMD -0.56, 95% CI [-1.04 to -0.08], I²=64%, p=0.002) or not (SMD -0.92, 95% CI [-1.35 to -0.51], I²=87%, p<0.0001). When CHM was used equally an offshoot to RAS inhibitors, estimated glomerular filtration rate was higher in the CHM than placebo group (Doc vi.28 mL/min; 95% CI [2.42 to x.xiv], Iⁱⁱ=0%, p=0.001). The effects of CHM on progression to ESKD and bloodshed were uncertain due to low effect rates. The reported adverse events in CHM group included digestive disorders, elevated liver enzyme level, infection, anaemia, hypertension and subarachnoid bleeding, but the report rates were low and similar to command groups. The favourable results of CHM should be balanced with the limitations of the included studies such as high heterogeneity, short follow-upwards periods, small numbers of clinical events and older patients with less advanced illness.

Conclusions: Based on moderate to low quality evidence, CHM may have beneficial effects on renal function and albuminuria beyond that afforded by conventional treatment in adults with DKD. Further well-conducted, adequately powered trials with representative DKD populations are warranted to confirm the long-term effect of CHM, particularly on clinically relevant outcomes.

Prospero registration number: CRD42015029293.

Keywords: Chinese herbal medicine; complementary and alternative medicine; diabetic kidney disease; meta-analysis; systematic review.

© Writer(s) (or their employer(s)) 2019. Re-apply permitted nether CC BY-NC. No commercial re-apply. See rights and permissions. Published by BMJ.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of searching and screening.

Figure two

Risk-of-bias (ROB) of included studies Notation: The red dot indicates high ROB, yellowish indicates unclear ROB and greenish dot indicates low ROB.

Figure 3

Forest plot of primary outcomes annotation: Panel (A) albuminuria outcomes; (B) proteinuria outcomes; (C) serum creatinine outcomes; (D) estimated glomerulus filtration rate outcomes. ACEi, angiotensin converting enzymeinhibitors; ARB, angiotensin receptor blockers; CHM, Chinese herbal medicine; Std, standard.

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Source: https://pubmed.ncbi.nlm.nih.gov/31048437/

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