Abstract
Primary nephrotic syndrome (PNS) is a common renal disease that presents with heavy proteinuria and hypoalbuminemia. Despite notable advances in its treatment, some patients show poor responses and clinical outcomes when treated with conventional Western medicine (WM). Chinese herbal injections (CHIs) have been reported to have beneficial effects for PNS. The aim of the present study was to comprehensively determine the efficacy and safety of CHIs for PNS in adults using a network meta-analysis approach. PubMed, Embase, the Cochrane library, and four Chinese databases were systematically searched to identify randomized controlled trials (RCTs) using CHIs for treatment of PNS published before June 1, 2019. Quality assessment of the identified RCTs was performed according to the Cochrane Handbook. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated for discrete or continuous variables, respectively. The primary outcome was complete/total remission and secondary outcomes were serum albumin and urinary protein excretion. The surface under the cumulative ranking curve (SUCRA) value and cluster analyses were used to rank treatment by probability. Eighty-five studies involving 11 CHIs and 5801 subjects were included. Compared with WM alone, CHI plus WM showed an improved complete/total remission rate as well as higher serum albumin and lower 24-hour urinary protein excretion, except in the following: Yinxingye injection plus WM did not improve the total remission rate, and Dengzhanhua or Xueshuantong injection plus WM did not lower the 24-hour urinary protein excretion. Either Danhong (DH) or Dengzhanhua (DZH) injection plus WM was the preferable treatment for PNS based on SUCRA and cluster analyses of clinical remission and adverse events. However, considering that literature in this area is limited, these results need further validation. CHIs administered as adjuvants to WM showed favourable outcomes for PNS. DH + WM and DZH + WM might be the potential optimal therapies for PNS.
Highlights
Primary nephrotic syndrome (PNS) is a prevalent glomerular disease characterised by excessive proteinuria and hypoalbuminemia, manifesting with histological differences, such as minimal change disease and membranous nephropathy [1]
Eleven Chinese herbal injections (CHIs) were reported in these randomized controlled trials (RCTs): Chuanxiongqin (CXQ), Danshen (DS), Danshenchuanxiongqin (DSCX), Danhong (DH), Dengzhanhua (DZH), Fufangdanshen (FFDS), Huangqi (HQ), Shenkang (SK), Shuxuetong (SXT), Yinxingye (YXY), and Xueshuantong (XST) injection. ere were 5801 participants (3331 males and 2470 females) enrolled in the 85 RCTs
In the present Network meta-analysis (NMA), the use of eleven CHIs as adjuvants to Western medicine (WM) in PNS was comprehensively compared based on the outcomes of clinical remission, urinary protein excretion, serum albumin, total cholesterol (TC), triglycerides, serum creatinine, and adverse reactions (ADRs). e treatments evaluated in this study were CXQ + WM, DS + WM, DSCX + WM, DH + WM, DZH + WM, FFDS + WM, HQ + WM, SK + WM, SXT + WM, YXY + WM, and XST + WM. e results suggested that CHIs plus conventional Western pharmaceutical agents are associated with significantly better measured PNS outcomes than WM alone
Summary
Primary nephrotic syndrome (PNS) is a prevalent glomerular disease characterised by excessive proteinuria and hypoalbuminemia, manifesting with histological differences, such as minimal change disease and membranous nephropathy [1]. Traditional Chinese medicine (TCM) has been documented to have a beneficial effect for PNS diagnosed based on individual symptoms, but not the pathological type; TCM might be a potential adjuvant or alternative treatment for PNS [8,9,10]. Several traditional pairwise metaanalyses have suggested that CHIs might be effective treatments for PNS [12, 13]. Since pairwise metaanalyses only directly compare two interventions, a Evidence-Based Complementary and Alternative Medicine comparison of the therapeutic effects of many different CHIs for PNS has not been performed. Erefore, in this study, NMA was used to determine the relative efficacy and safety of different CHIs for PNS and predict the best candidate treatment Network meta-analysis (NMA) can give a unified, coherent analysis of direct and indirect evidence as well as rank the probability of optimal treatment. erefore, in this study, NMA was used to determine the relative efficacy and safety of different CHIs for PNS and predict the best candidate treatment
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