Abstract

Purpose: We investigated the effects of Traditional Chinese Medicine (TCM) on the occurrence and progression of albuminuria in patients with type 2 diabetes.Methods: In this randomized, double-blind, multicenter, controlled trial, we enrolled 600 type 2 diabetes without diabetic nephropathy (DN) or with early-stage DN. Patients were randomly assigned (1:1) to receive Liuwei Dihuang Pills (LWDH) (1.5 g daily) and Ginkgo biloba Tablets (24 mg daily) orally or matching placebos for 24 months. The primary endpoint was the change in urinary albumin/creatinine ratio (UACR) from baseline to 24 months.Results: There were 431 patients having UACR data at baseline and 24 months following-up in both groups. Changes of UACR from baseline to follow-up were not affected in both groups: −1.61(−10.24, 7.17) mg/g in the TCM group and −0.73(−7.47, 6.75) mg/g in the control group. For patients with UACR ≥30 mg/g at baseline, LWDH and Ginkgo biloba significantly reduced the UACR value at 24 months [46.21(34.96, 58.96) vs. 20.78(9.62, 38.85), P < 0.05]. Moreover, the change of UACR from baseline to follow-up in the TCM group was significant higher than that in the control group [−25.50(−42.30, −9.56] vs. −20.61(−36.79, 4.31), P < 0.05].Conclusion: LWDH and Ginkgo biloba may attenuate deterioration of albuminuria in type 2 diabetes patients. These results suggest that TCM is a promising option of renoprotective agents for early stage of DN.Trial registration: The study was registered in the Chinese Clinical Trial Registry. (no. ChiCTR-TRC-07000037, chictr.org)

Highlights

  • Diabetic nephropathy (DN) is one of the most common causes of end-stage renal disease (ESRD) world widely, accounting for considerable morbidity and mortality in patients with both type 1 and type 2 diabetes mellitus (DM) [1, 2]

  • We investigated the effects of Traditional Chinese Medicine (TCM) on the occurrence and progression of albuminuria in patients with type 2 diabetes

  • Changes of urinary albumin/creatinine ratio (UACR) from baseline to follow-up were not affected in both groups: −1.61(−10.24, 7.17) mg/g in the TCM group and −0.73(−7.47, 6.75) mg/g in the control group

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Summary

Introduction

Diabetic nephropathy (DN) is one of the most common causes of end-stage renal disease (ESRD) world widely, accounting for considerable morbidity and mortality in patients with both type 1 and type 2 diabetes mellitus (DM) [1, 2]. Estimated GFR and albuminuria are independent risk factors which associate with progression to ESRD strongly [3]. The present management for microalbuminuria includes strict control of blood glucose and blood pressure, with the ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB). These therapies, are frequently unsatisfactory, probably reflecting inadequate targeting on the pathophysiology [4]. The use of ACEI/ARB failed to stop the progression of nephropathy to ESRD in type 2 patients [5]. The albuminuria was demonstrated to have positive correlation with renal risk in patients with type 2 diabetic nephropathy (DN) [6]. Previous clinical trial shows that initial reduction of albuminuria can reduce the risk of ESRD [8]

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