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. 2023 Feb 17:14:1028257.
doi: 10.3389/fphar.2023.1028257. eCollection 2023.

Efficacy of traditional Chinese medicine injection for diabetic kidney disease: A network meta analysis and systematic review

Caiyi Long  1   2 , Haoyue Feng  1   2 , Zheng Liu  1   2 , Zihan Li  1   2 , Jun Liu  3 , Yayi Jiang  1   2 , Rensong Yue  1
Affiliations

Efficacy of traditional Chinese medicine injection for diabetic kidney disease: A network meta analysis and systematic review

Caiyi Long et al. Front Pharmacol. .

Abstract

Background: Diabetic kidney disease (DKD) is an important public health problem worldwide that increases the mortality of patients and incurs high medical costs. Traditional Chinese Medicine injections (TCMIs) are widely used in clinical practice. However, their efficacy is unknown owing to a lack of definitive evidence. This study conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of traditional Chinese medicine injections in the treatment of DKD to provide a reference for clinical treatment. Methods: Total 7 databases had been searched, which included PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese scientific journal database (VIP), WanFang, and SinoMed. Only randomised controlled trials (RCT) had been included for analysis. The retrieval time limit was from the establishment of the database until 20 July 2022. Cochrane Risk of Bias 2.0 tool was used to evaluate the quality of the studies. Network meta-analyses, and Trial Sequential Analyses (TSA) were used to analysis the effectiveness of the included RCTs for DKD. The Stata 15.1 and R 4.0.4 were used to perform the network meta-analysis. Sensitivity analysis was used to assess the robustness of the findings. The effect of the intervention evidence are summarized on the basis of the minimum background framework. Results: NMA showed that the total effective rate of SMI, DCI, DHI, HQI, and SKI combined with alprostadil injection (PGE1) was better than PGE1 single used. Based on the surface under the cumulative ranking curve values, PGE1+DHI was the most effective for urinary albumin excretion rate and 24 h urinary albumin, PGE1+HQI was the most effective for the total response rate and β2-MG, and PGE1+SKI was the most effective for serum creatinine and blood urea nitrogen. Cluster analysis found that PGE1+HQI and PGE1+SKI could be the best treatments in terms of primary outcome measures. PGE1+SKI was found to be most effective on glomerular filtration function. PGE1+DHI was most effective for urinary protein-related indices. Conclusion: The efficacy of TCMI combined with PGE1 was higher than PGE1 single used. PGE1+HQI and PGE1+SKI were the most effective treatments. The safety of TCMI treatment should be investigated further. This study needs to be validated using large-sample, double-blind, multicentre RCTs. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=348333], identifier [CRD42022348333].

Keywords: diabetic kidney disease; injections; network meta-analysis; randomized controlled trial; traditional medicine.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study flow diagram.
FIGURE 2
FIGURE 2
Network diagrams for different outcomes.
FIGURE 3
FIGURE 3
Plot of the surface under the cumulative ranking curves.
FIGURE 4
FIGURE 4
Cluster diagram of primary outcome indicators.
FIGURE 5
FIGURE 5
Clustering diagram of Scr and BUN.
FIGURE 6
FIGURE 6
Clustering diagram of 24h Alb and UAER.
FIGURE 7
FIGURE 7
Funnel plots for total effective rate.
FIGURE 8
FIGURE 8
Funnel plots for Scr.
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Publication types

Grants and funding

The study was supported by Sichuan Provincial Administration of Traditional Chinese Medicine (2020LC0153) and Sichuan Science and Technology Foundation (2021YFS0037).