Objective To evaluate the effectiveness and safety of spironolactone for diabetic nephropathy. Methods We electronically searched CENTRAL (issue 3, 2008), MEDLINE (1950 to August 2008), EMbase (1984 to August 2008), CNKI (1994 to September 2008), and VIP (1989 to August 2008). We also checked the reference lists of all papers identified for further trials. Randomized controlled trials (RCTs) and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions. Results Three RCTs were included. Meta-analysis was not performed due to heterogeneity. Trials showed that spironolactone might decrease urinary albumin excretion, but could scarcely play an important role on kidney function and blood pressure. Conclusion Affirmative assessment cannot be made about the effectiveness and safety of spironolactone for diabetic nephropathy according to the limited existing trials. Large-scale, high-quality RCTs are needed to confirm or refuse the available evidence.
Objective To perform a meta-analysis and investigate the correlation between angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism and type 2 diabetic nephropathy, assessing the bias of small sample size study and heterogeneity between studies. Methods MEDLINE, EBSCO, EMbase, PubMed, CHKD, CNKI, CBM, VIP and WanFang Data were searched (from January 1994 to March 18th 2011) for relevant case-control studies. Two reviewers independently identified the literature according to inclusion and exclusion criteria. Also references of the included literature were retrieved. Then data were extracted and assessed by the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.0.0 software. Results A total of 61 studies comprising 9 979 cases and 7 252 control subjects were included. There was b evidence of heterogeneity (Plt;0.05, I2=60%) and a random effect model was employed to summarize the data. Results of meta-analysis showed that T2DM patients with II genotype had lower incidences of DN than those with DD+DI genotype (OR=0.65, 95%CI 0.57 to 0.74). The results of subgroup meta-analysis showed that Chinese, Japanese and Brazilians patients with II genotype had lower incidences of DN. However, there were no relation among Caucasus, Middle-East, Indian, Mexican, Korean, and Malaysian patients. Conclusion As for T2DM patients, their angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism relates to DN. T2DM patients with II genotype have lower incidences of DN. But the difference of this relation varies with ethnicity.
Objective To evaluate the efficacy and safety of tripterygium for diabetic nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of tripterygium for biabetic nephropathy were collected from The Cochrane Library (Issue 1, 2010), MEDLINE (1996 to March 2010), CNKI (1994 to March 2010), and CBM (1978 to March 2010). Two reviewers evaluated the quality of the trials and extracted the data independently. RevMan 5.0 software was used for meta-analyses. Results A total of 12 RCTs involving 862 patients were identified. The methodology of the included trials was poor and potential publication bias existed. The meta-analyses results showed: (1) Compared with the conventional treatment, the tripterygium showed more effects in reducing the 24-hour urinary protein (Clinical phase: WMD= –0.49, 95%CI –0.63 to –0.34, No phase: WMD= –0.60, 95%CI –0.96 to –0.24), and the urinary albumin excretion rate (UAER) (WMD= –148.75, 95%CI –238.01 to –59.48) was higher than that of the conventional treatment. (2) There were no significant differences between the two groups in the effect on the serum creatinine (Clinical phase: WMD= –8.43, 95%CI –18.15 to 1.29, No phase: WMD= –0.66, 95%CI –2.12 to 0.79) and creatinine clearance rate (WMD= 1.74, 95%CI –6.34 to 9.83). (3) Without enough data, it was uncertain to define the effect of tripterygium on lipids, blood pressure of the DN patients. (4) No severe adverse events or allergic reactions were reported. Conclusion Tripterygium may be a kind of medicine relatively safe and effective for diabetic nephropathy. However, the evidence is not b enough because of some low-quality trials and publication bias. Rigorously-designed, randomized, double-blind, and placebo-controlled trials of tripterygium for diabetic nephropathy are needed to further assess the effect.
Objective To carry out Meta analyses about the published literature that concerns Kaishi injection curing diabetic nephropathy, and to evaluate the efficacy and safety of Kaishi injection for diabetic nephropathy. Methods We searched the following databases: PubMed (1995 to 2010), EMCC (1995 to 2010), CBM (1995 to 2010), CNKI (1995 to 2010), and VIP (1989 to 2010) to collect randomized controlled trials (RCTs) of Kaishi injection curing diabetic nephropathy. The selection of studies, assessment of methodological quality and data extraction were performed independently by two reviewers. According to predefined inclusion and exclusion criteria Cochrane systematic review methods, the methodological quality assessment was undertaken, and meta-analyses were performed by using The Cochrane Collaboration’s RevMan 4.2.8 software. Evolution index were included: UAER, Scr, BUN, and 24 hours urinary protein.Results The literature included 19 RCTs with a total of 1 153 cases. Among them, 594 cases belonged to the treatment group and the control group included 559 ones. The studies of baseline data were comparable, and all reported that there were random methods but did not mention blinding and allocation concealment. Only one mentioned references to a listof random numbers by random grouping. The results of meta-analyses indicated that Kaishi injection was superior to routine treatment in decreasing UAER [WMD= – 77.86, 95%CI (– 85.64, – 70.08)], Scr [WMD= – 3.14, 95%CI (– 5.30, – 0.98)], BUN [WMD= – 0.71, 95%CI (– 1.13, – 0.29)], and 24 hours urinary protein [WMD= – 0.56, 95%CI (– 0.79, – 0.33)]. Conclusion The treatment of the diabetic nephropathy of Kaishi injection is superior to the conventional therapy. However, because of few high quality literature and limited sample size, further study is needed.
Objective To evaluate the effectiveness and safety of Dan hong injection for treating diabetic nephropathy (DN). Methods We electronically searched CENTRAL (the second issue 2009), MEDLINE (1980-2009.6), EMBASE (1980-2009.6), CNKI (1994-2009.6), CBM (1990-2009.6), WANG FANG (1984-2009.6) and VIP (1989-2009.6) to June 2009, and reference lists of all papers identified also were checked. Randomized controlled trials (RCTs), quasi- RCTs and cross-over studies were identified and assessed according to the Cochrane Handbook for Systematic Reviews of Interventions, and then Revman 5.0 was used to undertake meta analysis. Results Ten RCTs of 736 patients of diabetic nephropathy were included. Meta analyses showed that Dan hong injection was superior to routine treatment in decreasing UAER [MD= – 27.08, 95%CI (– 30.40, – 24.02)], Hb1AC [MD= – 1.12, 95%CI (– 1.67, – 0.56)] and FDP [MD= – 2.28, 95%CI (– 2.70, – 1.86)]; and Dan hong had similar effects in reducing the 24 hours proteinuria [MD= – 0.03, 95%CI (– 0.10, 0.04)], serum creatinine [MD= – 1.00, 95%CI (– 7.86, 5.86)], endogenous creatinine clearance rate [MD= – 2.30, 95%CI (– 15.51, 10.91)], blood cholesterol [MD= – 0.10, 95%CI (– 0.68, 0.48)], blood triglyceride [MD= – 0.15, 95%CI (– 0.36, 0.05)] and fasting blood sugar [MD= – 0.10, 95%CI (– 0.68, 0.48)]; However, Dan hong had more effective action on decreasing the UAER [MD= – 13.14, 95%CI (– 18.00, – 8.27)], blood cholesterol (Plt;0.05) and triglyceride (Plt;0.05) comparing with Dan shen, and on reducing 24 hour albuminuria (Plt;0.05) and FDP (Plt;0.05) with Mai luoning; no significant adverse effects or allergic reactions were reported. Conclusion Dan hong can improve UAER of DN; conclusive results cannot be made about the effectiveness and safety of dan hong for diabetic nephropathy according to limited existing trials. Larger and higher quality randomized controlled trials are needed to assess the available evidence.
Objective To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ willingness was also taken into consideration in the decision-making treatment Results Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative. Conclusion The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.
Objective To assess the therapeutic effect of sulodexide for diabetic patients with early nephropathy. Methods A total of 60 patients with early diabetic nephropathy (albuminuria: 30 to 300 mg/24 h, male/female: 30/30, mean age: 51.23 years, mean course of disease: 12.9 years) were randomized equally into three groups: the routine treatment group, cozaar group (50 mg qd, po for 12 weeks) and sulodexid group (600 LSU qd, iv or im for 4 weeks, 250 LSU bid, po for 8 weeks). The levels of urinary albumin excretion rate (UAER), urea nitrogen and creatinine were determined. Results After three months of treatment, the level of UAER was decreased significantly in both the sulodexide group and cozaar group (Plt;0.01), but not in the routine treatment group (Pgt;0.05). The level of UAER was reduced by 34.04% and 33.62% in the cozaar group and the sulodexide group, respectively. Significant difference was noted in the level of UAER between the cozaar/sulodexide groups and the routine treatment group (Plt;0.01), but no significant difference was observed between cozaar group and sulodexide group (Pgt;0.05). Conclusion Sulodexide could decrease the level of UAER in patients with early diabetic nephropathy. It has similar efficacy to cozaar.
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
ObjectiveTo explore the clinical curative effect of high flux hemodialysis on diabetic nephropathy (DN) and impact on patients' insulin resistance (IR). MethodsA total of 96 patients with DN meeting the inclusion criteria treated between January 2013 and January 2014 were selected. The patients were randomly divided in to the observation group and control group with 48 in each. The control group received low flux hemodialysis, while the observation group underwent high flux hemodialysis. Before the treatment and in the first half of the year after the treatment, the clinical renal function and inflammatory indexes, lipid metabolism, and glucose metabolism related markers were recorded, and IR index (HOMA-IR) were calculated and compared. ResultsBefore and after the treatment, the Kt/V showed no significant change in the two groups (P > 0.05). Serum creatinine levels was lower after the treatment compared with that before the treatment in both of the two groups; in the observation group, C-reactive protein, interleukin-6 and tumor necrosis factorαwere significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). HOMA-IR and fasting insulin levels in the observation group after the treatment were significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). No significant changes of fasting plasma glucose and glycosylated hemoglobin levels in the two groups before and after the treatment in patients were found (P > 0.05). ConclusionHigh flux hemodialysis therapy is effective on DN, which can effectively remove the body and large molecular type of inflammatory mediators, alleviate the micro inflammatory state, improve the IR status and correct the lipid metabolic abnormalities.
ObjectiveTo investigate the protective effect of Roux-en-Y gastric bypass surgery on early damage of renal tissue in type 2 diabetes mellitus rats, and explore the mechanism of the protective effects. MethodsDiabetes mellitus animal models were induced by intraperitoneal injection of streptozotocin (STZ, 35 mg /kg) and a high-fat diet.Diabetic rats were divided into three groups randomly (digital table method): diabetes control group (n=8), sham operation group (n=8), and Roux-en-Y gastric bypass group (n=14).Another 8 normal SD rats as the normal control group.The fasting blood glucose, serum total cholesterol (TC), triglyceride (TG), and free fatty acid (FFA) were measured before operation and in 8 weeks after operation; plasma BUN and Cr were measured respectively before operation and in 4 and 8 weeks after operation in each group rats, 24 h urine microalbumin and urine 8-hydroxydeoxyguanosine were measured respectively before operation and in 8 weeks after operation in each group rats.Renal pathological changes were observed and the indexes of kidney hypertrophy, the mean glomerular area (MGA), and the mean glomerular volume (MGV) were analyzed in 8 weeks after operation.The expressions of fibronectin, typeⅣcollagen (CoⅣ), transforming growth factor-β1 (TGF-β1), intercellular adhesion molecule-1(ICAM-1), nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), and Bcl-2 protein in renal tissues were investigated by immunohistochemical staining. ResultsRoux-en-Y gastric bypass surgery could reduce the blood glucose, blood lipid, MGA, MGV, and the index of kidney hypertrophy of diabetic rats significantly (P < 0.05), improved renal pathological morphology and kidney function (P < 0.05), reduced the protein expressions of fibronectin and CoⅣ, decreased the protein expressions of TGF-β1, ICAM-1, and NOX4, and increased the protein expression of Bcl-2. ConclusionRoux-en-Y gastric bypass surgery can improve kidney function and the pathological damage of diabetes rats, its mechanism may be related to inhibition the protein expressions of TGF-β1, ICAM-1, and NOX4, and increase the protein expression of Bcl-2.