Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). Many trials have shown that Abelmoschus manihot could further improve proteinuria and protect kidney function in patients with DN when added to a renin-angiotensin system (RAS) blocker. A systematic assessment of the e...
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doaj-1afef99574454d80b85bcfc4337570832020-11-24T22:11:41ZengHindawi LimitedEvidence-Based Complementary and Alternative Medicine1741-427X1741-42882019-01-01201910.1155/2019/96792349679234Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-AnalysisLiwei Shi0Ling Feng1Meizhen Zhang2Xiaowen Li3Yanan Yang4Yueying Zhang5Qing Ni6Department of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Health Care, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDepartment of Endocrinology, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, ChinaDiabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). Many trials have shown that Abelmoschus manihot could further improve proteinuria and protect kidney function in patients with DN when added to a renin-angiotensin system (RAS) blocker. A systematic assessment of the efficacy and safety of A. manihot in DN is essential. Eight electronic databases were searched to identify eligible trials published from inception to December 2017. The Cochrane Risk of Bias Tool was used to evaluate the methodological quality of eligible studies. Seventy-two studies with 5,895 participants were identified. The methodological quality of included studies was generally low. The results indicated that, compared to a RAS blocker, combined treatment of A. manihot with a RAS blocker was more effective for 24h urinary protein (24h UP) (mean difference [MD], -0.39 [95% confidence interval [CI], -0.46 to -0.33] g/d; P<0.00001), urinary albumin excretion rate (UAER)(MD, -19.90 [95% CI, -22.62 to -17.18] μg/min; P<0.00001), 24h UP reduction rate (risk ratio [RR], 1.43; 95% CI, 1.26-1.63; P<0.00001), normalization of UAER (RR, 1.48; 95% CI, 1.29-1.70; P<0.00001), and serum creatinine (SCr) (MD, -7.35 [95% CI, -9.95 to -4.76] umol/L; P<0.00001). None of these trials reported the ESRD rate. No statistically significant difference occurred between A. manihot combined with a RAS blocker and a RAS blocker alone in estimated glomerular filtration rate (eGFR) (MD, 4.43 [95% CI, -1.68 to 10.54] mL/min; P=0.16). A. manihot did not increase the rates of adverse drug events. A. manihot in addition to a RAS blocker was effective and safe to further improve proteinuria and protect kidney function in patients with DN. However, due to the generally low methodological quality, significant heterogeneity, and publication bias, high-quality randomized controlled trials are required to confirm these findings before the routine use of A. manihot can be recommended.http://dx.doi.org/10.1155/2019/9679234 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Liwei Shi Ling Feng Meizhen Zhang Xiaowen Li Yanan Yang Yueying Zhang Qing Ni |
spellingShingle |
Liwei Shi Ling Feng Meizhen Zhang Xiaowen Li Yanan Yang Yueying Zhang Qing Ni Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis Evidence-Based Complementary and Alternative Medicine |
author_facet |
Liwei Shi Ling Feng Meizhen Zhang Xiaowen Li Yanan Yang Yueying Zhang Qing Ni |
author_sort |
Liwei Shi |
title |
Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis |
title_short |
Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis |
title_full |
Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis |
title_fullStr |
Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis |
title_full_unstemmed |
Abelmoschus manihot for Diabetic Nephropathy: A Systematic Review and Meta-Analysis |
title_sort |
abelmoschus manihot for diabetic nephropathy: a systematic review and meta-analysis |
publisher |
Hindawi Limited |
series |
Evidence-Based Complementary and Alternative Medicine |
issn |
1741-427X 1741-4288 |
publishDate |
2019-01-01 |
description |
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). Many trials have shown that Abelmoschus manihot could further improve proteinuria and protect kidney function in patients with DN when added to a renin-angiotensin system (RAS) blocker. A systematic assessment of the efficacy and safety of A. manihot in DN is essential. Eight electronic databases were searched to identify eligible trials published from inception to December 2017. The Cochrane Risk of Bias Tool was used to evaluate the methodological quality of eligible studies. Seventy-two studies with 5,895 participants were identified. The methodological quality of included studies was generally low. The results indicated that, compared to a RAS blocker, combined treatment of A. manihot with a RAS blocker was more effective for 24h urinary protein (24h UP) (mean difference [MD], -0.39 [95% confidence interval [CI], -0.46 to -0.33] g/d; P<0.00001), urinary albumin excretion rate (UAER)(MD, -19.90 [95% CI, -22.62 to -17.18] μg/min; P<0.00001), 24h UP reduction rate (risk ratio [RR], 1.43; 95% CI, 1.26-1.63; P<0.00001), normalization of UAER (RR, 1.48; 95% CI, 1.29-1.70; P<0.00001), and serum creatinine (SCr) (MD, -7.35 [95% CI, -9.95 to -4.76] umol/L; P<0.00001). None of these trials reported the ESRD rate. No statistically significant difference occurred between A. manihot combined with a RAS blocker and a RAS blocker alone in estimated glomerular filtration rate (eGFR) (MD, 4.43 [95% CI, -1.68 to 10.54] mL/min; P=0.16). A. manihot did not increase the rates of adverse drug events. A. manihot in addition to a RAS blocker was effective and safe to further improve proteinuria and protect kidney function in patients with DN. However, due to the generally low methodological quality, significant heterogeneity, and publication bias, high-quality randomized controlled trials are required to confirm these findings before the routine use of A. manihot can be recommended. |
url |
http://dx.doi.org/10.1155/2019/9679234 |
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