Systematic Review of Rhubarb for Chronic Renal Failure_Chinese Journal of Evidence-Based Medicine

Authors：

LI Zi ¹ , QING Ping ² , JI Ling ¹ , SU Baihai ¹ , HE Li ³ , FAN Junming ¹

1. Department of Nephrology; West China Hospital; Sichuan University; Chengdu 610041; China2. Department of Teach ing; West China School of Medicine; Sichuan University; Chengdu 610041; China3. Department of Neurology; West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Rhubarb; Chronic renal failure; Systematic review

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Objective 　To assess the efficacy and safety of Rhubarb and adjunvent drugs for chronic renal failure.
Methods 　Electronic database searching including Medline, Cochrane Library and CBM from 1980 to Dec., 2000 was performed. Handsearching was applied to 15 kinds of nephrological and traditional Chinese medicine journals such as Chinese Journal of Nephology. Randomised and quasi-randomised trials concerning Rhubarb treatment for CRF were selected. The selected studies were assessed for their methodological quality and the data were extracted to perform the Meta-analysis.
Results 　Eighteen randomised and quasi-randomised trials including 1 322 patients met the inclusion criteria, but their methodological quality was low. Compared to non-specific treatment, Rhubarb showed significant positive effects on relieving symptoms, lowering serum creatinine, improving HGB and adjusting disturbance of lipid metabolism. The effect of Rhubarb on reducing the number of death [OR 0.15, 95%CI (0.06 to 0.36), P=0.000] and the number of progressing into end-stage renal disease [OR 0.38, 95%CI (0.09 to1.64), P=0.19] was not confirmed because of the small sample size.
Conclusions 　Rhubarb may have the same effect on CRF in the short-term observation. But its long-term effect of delaying the progression of CRF is still unclear. Well designed, randomised, double-blinded, placebo-controlled trials with long-term follow up and clinical related outcomes are warranted.

Citation： LI Zi,QING Ping,JI Ling,SU Baihai,HE Li,FAN Junming. Systematic Review of Rhubarb for Chronic Renal Failure. Chinese Journal of Evidence-Based Medicine, 2004, 04(7): 468-473. doi: Copy

1.	桑栋.中西医结合治疗慢性肾功能不全患者的疗效观察 [J].中国中西医结合急救杂志,1999; 6(8):367～369.
2.	［20］Zhu PJ,Zhou X,Wei XJ.Effect of Baoyuan Qiangsheng Ⅱtablet to plasma and urine SOD,MDA in chronic renal failre patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1997; 17(11):649-652.
3.	朱辟疆,周逊,韦先进.保元强肾Ⅱ号对慢性肾功能衰竭血浆及尿SOD、MDA的影响 [J].中国中西医结合杂志,1997; 17(11):649～652.
4.	［21］Zhang JH,Li LS,Zhang M.Clinical effects of rheum and captopril on preventing progression of chronic renal failure [J].Chinese Medical Journal,1990; 103(10):788-793.
5.	［22］Zheng PD.The discussion of the mechanism of rhubarb to treat azotemia [J].Shanghai Traditional Chinese Medicine,1985;(8):46.
6.	郑平东.大黄治疗氮质血症及其作用机制的探讨 [J].上海中医药杂志,1985; (8):46.
7.	［23］Liu JP,Liu C,Leng TJ.Evaluation of clinical trials for viral hepatitis in the past nine years in Chinese medical literatures [J].West China Medical Journal,1999; 14(3):264-265.
8.	刘建平,刘畅,冷泰俊.病毒性肝炎临床治疗试验9年文献评价[J].华西医学,1999; (3):264～265.
9.	［1］Yang JW,Li LS.The experiment study of Rhubarb delaying chronic renal failure [J].Journal of Chinese Nephrology,1993; 9(2):65-68.
10.	杨俊伟,黎磊石.大黄延缓慢性肾衰发展的实验研究 [J].中华肾脏病杂志,1993; 9(2):65～68.
11.	［2］Pedrini MT,Levey AS,Lau J,Chalmers TC,Wang PH.The effect of dietary protein restriction on the progressive of diabetic and nondiabetic renal disease [J].Ann Intern Med,1996; 124(7):627-632.
12.	［3］Giatral I,Lau J,Levey AS.Effect of angiotensin-converting enzyme inhibitor on the progression of nondiabetic renal disease:a meta-analysis of randomized trials.Angiotensin-Converting-Enzyme Inhibitor Progressive Renal Disease Study Group [J].Ann Intern Med,1997;127(5):337-345.
13.	［4］Wu XX.Clinical research of compound Rhubarb by rectal administration to delay the progression of chronic renal failure [J].New Traditional Chinese Medicine,1994; 26(6):24-25吴锡信.复方大黄灌肠液延缓慢性肾功能衰竭进展的临床研究 [J].新中医,1994; 26(6):24～25.
14.	［5］Sum WS,Qiao CL,Yang SX,Liu R,Zhou QF.The effect comparison between aid chi eliminate waste and aid chi invigorating kidney on chronic renal failure [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1996; 3(10):433-435.
15.	孙万森,乔成林,杨世兴,刘锐,周清发.益气泄浊法和益气补肾法治疗慢性肾功能衰竭疗效比较 [J].中西医结合实用临床急救,1996; 3(10):433～435.
16.	［6］Song HX,Wang ZF,Zhang FF,Zhou H.The detection of urine IL-6 and the effect of rhubarb on chronic renal failure patient [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(2):107-109.
17.	宋海翔,王子芬,张凤芳,周慧.慢性肾功能衰竭患者尿白细胞介素6的检测及大黄对其影响 [J].中国中西医结合杂志,2000; 20(2):107～109.
18.	［7］Li YL,Yang N,Lin KX.The protection function of traditional medicine,Man Shen Kang,to the resident renal function on hemodialytic patients [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(12):564-565.
19.	李燕林,杨楠,林凯旋.中药"慢肾康"对血液透析患者残余肾功能的保护作用观察 [J].中国中西医结合急救杂志,1999; 6(12):564～565.
20.	［8］Wang KL,Tan SF.The effect observation of combined Traditional Chinese and Western Medicine on uremia [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1998; 5(4):175-176.
21.	汪开莲,谭士芬.中西医结合救治尿毒症疗效观察 [J].中西医结合实用临床急救,1998; 5(4):175～176.
22.	［9］Wu ZM,Shi JL,Liu WM.Treatment of 60 chronic renal failure cases with Shen Shuai Ning capsule[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1998;18(9):558-559.
23.	吴仲明,师晶丽,刘为民.肾衰宁胶囊治疗慢性肾功能不全60例 [J].中国中西医结合杂志,1998;18(9):558～559.
24.	［10］Qou QA.The clinical observation of treatment of 48 chronic renal failure cases with Qian Cao Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.2000; 20(2):141-142.
25.	寇秋爱.仙草冲剂治疗48例慢性肾功能衰竭的临床观察 [J].中国中西医结合杂志,2000; 20(2):141～142.
26.	［11］Zhang SG,Xiong GL,Yang X.Primary clinical and experimental study of treatment of chronic renal insufficient with aid chi invigorating kidney Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1992; 12(6):335-337.
27.	［12］Chen YP,Liu WZ,Shen LM,Shen JF,Xu SN.The effect observation of traditional Chinese medicine to chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.1986; 6(8):465-467.
28.	陈以平,刘慰祖,沈玲妹,沈静芬,徐嵩年.中医中药治疗慢性肾功能衰竭疗效观察[J].中西医结合杂志,1986; 6(8):465～467.
29.	［13］Ji SM,Li LS,Ji DX.The clinical research of Baoshen Pill on maitainance hemodialysis patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1993; 13(2):71-73.
30.	季曙明,黎磊石,季大玺.保肾丸治疗长期血液透析患者的临床研究 [J].中国中西医结合杂志,1993; 13(2):71～73.
31.	［14］Yu YS,Li LS,Zhang X.The long-term effect observation of rhubarb to chronic renal failure [J].Journal of Nephrology Dialysis Transplantation,1995; 4(1):32-35.
32.	俞雨生,黎磊石,章旭.中药大黄治疗慢性肾衰的远期疗效观察 [J].肾脏病与透析肾移植杂志,1995; 4(1):32～35.
33.	［15］Zhang JH,Li LS,Wang BZ.The effect of rhubarb to lipid metabolism in chronic renal patients [J].Journal of Chinese Nephrology,1993; 9(3):133-135.
34.	张景红,黎磊石,万柏珍.大黄对慢性肾衰病人脂质代谢的影响 [J].中华肾脏病杂志,1993; 9(3):133～135.
35.	［16］Zhang JH,Yao XD,Song Y.The long-term effect of retarding chronic renal failure progression with rhubarb and catopril [J].Journal of Chinese Nephrology.1993; 9(4):197-201.
36.	张景红,姚小丹,宋岩.大黄与巯甲丙脯酸延缓慢性肾衰进展的远期疗效 [J].中华肾脏病杂志,1993; 9(4):197～201.
37.	［17］Li YY,Ren XF,Song Y.Treatment of 189 chronic renal failure cases with hemodialysis and retarding kidney soup [J].Journal of Traditional Chinese Medicine,1994; 35(8):483-484.
38.	李毓英,任秀芬,杨桂英.血液透析配合延肾汤治疗慢性肾功能衰竭189例 [J].中医杂志,1994; 35(8):483～484.
39.	［18］Yu YM,Cui JQ,Zhang F.Chinese drugs for invigorating spleen to remove dampness,activating blood circulation to eliminate turbid in retarding progression of chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(10):727-728.
40.	余月明,崔建强,张凡.健脾利湿、活血化浊中药延缓慢性肾功能衰竭 [J].中国中西医结合杂志,2000; 20(10):727～728.
41.	［19］Sang D.The effect observation of Integrated Traditional Chinese and Western Medicine to treat chronic renal failure [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(8):367-369.

1. 桑栋.中西医结合治疗慢性肾功能不全患者的疗效观察 [J].中国中西医结合急救杂志,1999; 6(8):367～369.
2. ［20］Zhu PJ,Zhou X,Wei XJ.Effect of Baoyuan Qiangsheng Ⅱtablet to plasma and urine SOD,MDA in chronic renal failre patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1997; 17(11):649-652.
3. 朱辟疆,周逊,韦先进.保元强肾Ⅱ号对慢性肾功能衰竭血浆及尿SOD、MDA的影响 [J].中国中西医结合杂志,1997; 17(11):649～652.
4. ［21］Zhang JH,Li LS,Zhang M.Clinical effects of rheum and captopril on preventing progression of chronic renal failure [J].Chinese Medical Journal,1990; 103(10):788-793.
5. ［22］Zheng PD.The discussion of the mechanism of rhubarb to treat azotemia [J].Shanghai Traditional Chinese Medicine,1985;(8):46.
6. 郑平东.大黄治疗氮质血症及其作用机制的探讨 [J].上海中医药杂志,1985; (8):46.
7. ［23］Liu JP,Liu C,Leng TJ.Evaluation of clinical trials for viral hepatitis in the past nine years in Chinese medical literatures [J].West China Medical Journal,1999; 14(3):264-265.
8. 刘建平,刘畅,冷泰俊.病毒性肝炎临床治疗试验9年文献评价[J].华西医学,1999; (3):264～265.
9. ［1］Yang JW,Li LS.The experiment study of Rhubarb delaying chronic renal failure [J].Journal of Chinese Nephrology,1993; 9(2):65-68.
10. 杨俊伟,黎磊石.大黄延缓慢性肾衰发展的实验研究 [J].中华肾脏病杂志,1993; 9(2):65～68.
11. ［2］Pedrini MT,Levey AS,Lau J,Chalmers TC,Wang PH.The effect of dietary protein restriction on the progressive of diabetic and nondiabetic renal disease [J].Ann Intern Med,1996; 124(7):627-632.
12. ［3］Giatral I,Lau J,Levey AS.Effect of angiotensin-converting enzyme inhibitor on the progression of nondiabetic renal disease:a meta-analysis of randomized trials.Angiotensin-Converting-Enzyme Inhibitor Progressive Renal Disease Study Group [J].Ann Intern Med,1997;127(5):337-345.
13. ［4］Wu XX.Clinical research of compound Rhubarb by rectal administration to delay the progression of chronic renal failure [J].New Traditional Chinese Medicine,1994; 26(6):24-25吴锡信.复方大黄灌肠液延缓慢性肾功能衰竭进展的临床研究 [J].新中医,1994; 26(6):24～25.
14. ［5］Sum WS,Qiao CL,Yang SX,Liu R,Zhou QF.The effect comparison between aid chi eliminate waste and aid chi invigorating kidney on chronic renal failure [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1996; 3(10):433-435.
15. 孙万森,乔成林,杨世兴,刘锐,周清发.益气泄浊法和益气补肾法治疗慢性肾功能衰竭疗效比较 [J].中西医结合实用临床急救,1996; 3(10):433～435.
16. ［6］Song HX,Wang ZF,Zhang FF,Zhou H.The detection of urine IL-6 and the effect of rhubarb on chronic renal failure patient [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(2):107-109.
17. 宋海翔,王子芬,张凤芳,周慧.慢性肾功能衰竭患者尿白细胞介素6的检测及大黄对其影响 [J].中国中西医结合杂志,2000; 20(2):107～109.
18. ［7］Li YL,Yang N,Lin KX.The protection function of traditional medicine,Man Shen Kang,to the resident renal function on hemodialytic patients [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(12):564-565.
19. 李燕林,杨楠,林凯旋.中药"慢肾康"对血液透析患者残余肾功能的保护作用观察 [J].中国中西医结合急救杂志,1999; 6(12):564～565.
20. ［8］Wang KL,Tan SF.The effect observation of combined Traditional Chinese and Western Medicine on uremia [J].Practical clinical emergency journal of Integrated Traditional Chinese with Western Medicine,1998; 5(4):175-176.
21. 汪开莲,谭士芬.中西医结合救治尿毒症疗效观察 [J].中西医结合实用临床急救,1998; 5(4):175～176.
22. ［9］Wu ZM,Shi JL,Liu WM.Treatment of 60 chronic renal failure cases with Shen Shuai Ning capsule[J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1998;18(9):558-559.
23. 吴仲明,师晶丽,刘为民.肾衰宁胶囊治疗慢性肾功能不全60例 [J].中国中西医结合杂志,1998;18(9):558～559.
24. ［10］Qou QA.The clinical observation of treatment of 48 chronic renal failure cases with Qian Cao Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.2000; 20(2):141-142.
25. 寇秋爱.仙草冲剂治疗48例慢性肾功能衰竭的临床观察 [J].中国中西医结合杂志,2000; 20(2):141～142.
26. ［11］Zhang SG,Xiong GL,Yang X.Primary clinical and experimental study of treatment of chronic renal insufficient with aid chi invigorating kidney Chongji [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1992; 12(6):335-337.
27. ［12］Chen YP,Liu WZ,Shen LM,Shen JF,Xu SN.The effect observation of traditional Chinese medicine to chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine.1986; 6(8):465-467.
28. 陈以平,刘慰祖,沈玲妹,沈静芬,徐嵩年.中医中药治疗慢性肾功能衰竭疗效观察[J].中西医结合杂志,1986; 6(8):465～467.
29. ［13］Ji SM,Li LS,Ji DX.The clinical research of Baoshen Pill on maitainance hemodialysis patients [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,1993; 13(2):71-73.
30. 季曙明,黎磊石,季大玺.保肾丸治疗长期血液透析患者的临床研究 [J].中国中西医结合杂志,1993; 13(2):71～73.
31. ［14］Yu YS,Li LS,Zhang X.The long-term effect observation of rhubarb to chronic renal failure [J].Journal of Nephrology Dialysis Transplantation,1995; 4(1):32-35.
32. 俞雨生,黎磊石,章旭.中药大黄治疗慢性肾衰的远期疗效观察 [J].肾脏病与透析肾移植杂志,1995; 4(1):32～35.
33. ［15］Zhang JH,Li LS,Wang BZ.The effect of rhubarb to lipid metabolism in chronic renal patients [J].Journal of Chinese Nephrology,1993; 9(3):133-135.
34. 张景红,黎磊石,万柏珍.大黄对慢性肾衰病人脂质代谢的影响 [J].中华肾脏病杂志,1993; 9(3):133～135.
35. ［16］Zhang JH,Yao XD,Song Y.The long-term effect of retarding chronic renal failure progression with rhubarb and catopril [J].Journal of Chinese Nephrology.1993; 9(4):197-201.
36. 张景红,姚小丹,宋岩.大黄与巯甲丙脯酸延缓慢性肾衰进展的远期疗效 [J].中华肾脏病杂志,1993; 9(4):197～201.
37. ［17］Li YY,Ren XF,Song Y.Treatment of 189 chronic renal failure cases with hemodialysis and retarding kidney soup [J].Journal of Traditional Chinese Medicine,1994; 35(8):483-484.
38. 李毓英,任秀芬,杨桂英.血液透析配合延肾汤治疗慢性肾功能衰竭189例 [J].中医杂志,1994; 35(8):483～484.
39. ［18］Yu YM,Cui JQ,Zhang F.Chinese drugs for invigorating spleen to remove dampness,activating blood circulation to eliminate turbid in retarding progression of chronic renal failure [J].Chinese Journal of Integrated Traditional Chinese and Western Medicine,2000; 20(10):727-728.
40. 余月明,崔建强,张凡.健脾利湿、活血化浊中药延缓慢性肾功能衰竭 [J].中国中西医结合杂志,2000; 20(10):727～728.
41. ［19］Sang D.The effect observation of Integrated Traditional Chinese and Western Medicine to treat chronic renal failure [J].Chinese emergence Journal of Integrated Traditional Chinese and Western Medicine,1999; 6(8):367-369.

Chinese Journal of Evidence-Based Medicine

Systematic Review of Rhubarb for Chronic Renal Failure

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