Abstract
As the current treatment of chronic kidney disease (CKD) is limited, it is necessary to seek more effective and safer treatment methods, such as Chinese herbal medicines (CHMs). In order to clarify the modern theoretical basis and molecular mechanisms of CHMs, we reviewed the knowledge based on publications in peer-reviewed English-language journals, focusing on the anti-inflammatory, antioxidative, anti-apoptotic, autophagy-mediated and antifibrotic effects of CHMs commonly used in kidney disease. We also discussed recently published clinical trials and meta-analyses in this field. Based on recent studies regarding the mechanisms of kidney disease in vivo and in vitro, CHMs have anti-inflammatory, antioxidative, anti-apoptotic, autophagy-mediated, and antifibrotic effects. Several well-designed randomized controlled trials (RCTs) and meta-analyses demonstrated that the use of CHMs as an adjuvant to conventional medicines may benefit patients with CKD. Unknown active ingredients, low quality and small sample sizes of some clinical trials, and the safety of CHMs have restricted the development of CHMs. CHMs is a potential method in the treatment of CKD. Further study on the mechanism and well-conducted RCTs are urgently needed to evaluate the efficacy and safety of CHMs.
Highlights
Chronic kidney disease (CKD), characterized by a glomerular filtration rate (GFR) of less than 60 ml/min/ 1·73 m2 and/or markers of kidney damage, is an increasing public health issue because of its high prevalence and increased risk of end-stage renal disease (ESRD), cardiovascular disease, and premature death (Matsushita et al, 2010; Webster et al, 2017)
In order to clarify the modern theoretical basis and molecular mechanisms of Chinese herbal medicines (CHMs), we reviewed the knowledge based on publications in peer-reviewed English-language journals, focusing on the anti-inflammatory, antioxidative, anti-apoptotic, autophagymediated and antifibrotic effects of CHMs commonly used in kidney disease
In order to clarify the modern theoretical basis and molecular mechanisms of CHMs, we reviewed the knowledge based on publications in peer-reviewed English-language journals, focusing on the anti-inflammatory, antioxidative, anti-apoptotic, autophagy-mediated, and antifibrotic effects of CHMs commonly used in kidney disease
Summary
Chronic kidney disease (CKD), characterized by a glomerular filtration rate (GFR) of less than 60 ml/min/ 1·73 m2 and/or markers of kidney damage, is an increasing public health issue because of its high prevalence and increased risk of end-stage renal disease (ESRD), cardiovascular disease, and premature death (Matsushita et al, 2010; Webster et al, 2017). Reviewing RCTs of diabetic nephropathy, a meta-analysis included 12 studies with 1,030 patients, and showed that the combination of salvianolate and Western medicine had renoprotective, anti-inflammatory, and antioxidative effects by reducing levels of SCr, blood urea nitrogen (BUN), urine protein, hypersensitive C-reactive protein (CRP), interleukin-6, MDA, as well as increasing the level of SOD. To evaluate the efficacy and safety of a sodium tanshinone IIA sulfonate injection, the extractive of Salvia miltiorrhiza Bunge, in the treatment of hypertensive nephropathy, a systematic review and metaanalysis included 16 trials comprising 1,696 participants, and indicated that sodium tanshinone IIA sulfonate in combination with an ARB was more effective than ARB monotherapy in improving the eGFR level and reducing 24 h-UP, SCr, cystatin-C, urinary immunoglobulin G, and urinary transferrin levels. Reviewing RCTs of diabetic nephropathy, a meta-analysis included 10 studies with 669 patients; the authors showed that puerarin combined with an ACEI significantly decreased the UAER, but it had no effect on 24 h-UP, BUN, and SCr levels. Panax notoginseng (Burkill) F.H.Chen can significantly improve renal function and lipid metabolism in diabetic nephropathy
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