Abstract
To evaluate the effect of Chinese herbal medicine (CHM) on albuminuria levels in patients with diabetic nephropathy (DN), we performed comprehensive searches on Medline database, Cochrane Library, CNKI database, CBM database, Wanfang database, and VIP database up to December 2012. A total of 29 trials including 2440 participants with DN met the selection criteria. CHM was tested to be more effective in reducing urinary albumin excretion rate (UAER) (MD −82.95 μg/min, [−138.64, −27.26]) and proteinuria (MD −565.99 mg/24 h, [−892.41, −239.57]) compared with placebo. CHM had a greater beneficial effect on reduction of UAER (MD −13.41 μg/min, [−20.63, −6.19]) and proteinuria (MD −87.48 mg/24 h, [−142.90, −32.06]) compared with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Combination therapy with CHM and ACEI/ARB showed significant improvement in UAER (MD −28.18 μg/min, [−44.4, −11.97]), urinary albumin-creatinine ratio (MD −347.00, [−410.61, −283.39]), protein-creatinine ratio (MD −2.49, [−4.02, −0.96]), and proteinuria (MD −26.60 mg/24 h, [−26.73, −26.47]) compared with ACEI/ARB alone. No serious adverse events were reported. CHM seems to be an effective and safe therapy option to treat proteinuric patients with DN, suggesting that further study of CHM in the treatment of DN is warranted in rigorously designed, multicentre, large-scale trials with higher quality worldwide.
Highlights
Diabetic nephropathy (DN), defined as the presence of micro- or macroalbuminuria in patients with diabetes, is the most common cause of end-stage renal disease (ESRD) across the world [1]
Chinese herbal medicine (CHM), which can produce a potential effect of multitarget therapy and block these pathways, seems appropriate in the treatment of DN caused by multiple factors [10]
Based on the meta-analysis of 29 randomized controlled trials, CHM was tested to be more effective in reducing urinary albumin excretion rate (UAER) and proteinuria compared with placebo or Angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)
Summary
Diabetic nephropathy (DN), defined as the presence of micro- or macroalbuminuria in patients with diabetes, is the most common cause of end-stage renal disease (ESRD) across the world [1]. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been demonstrated to reduce albuminuria and delay the progression of DN by inhibition of renin-angiotensin system (RAS) and have become the standard of care for albuminuric patients [7, 8]. Despite the renoprotective effects of ACEI and ARB, diabetic nephropathy progresses to ESRD in a large proportion of patients [9]. This indicates that in addition to the RAS, other pathways are involved in the pathogenesis of DN. Chinese herbal medicine (CHM), which can produce a potential effect of multitarget therapy and block these pathways, seems appropriate in the treatment of DN caused by multiple factors [10]
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