Liuwei Dihuang Pills Enhance the Effect of Western Medicine in Treating Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials

Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2016, Article ID 1509063, 9 pages http://dx.doi.org/10.1155/2016/1509063 Review Article Liuwei Dihuang Pills Enhance the Effect of Western Medicine in Treating Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials Lan Lin,1 Qiuhong Wang,1 Yongxin Yi,1 Shihan Wang,2 and Zonglin Qiu1 1 Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing 100053, China 2 Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China Correspondence should be addressed to Qiuhong Wang; Received 17 December 2015; Accepted 19 January 2016 Academic Editor: Giuseppe Caminiti Copyright © 2016 Lan Lin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To assess the effectiveness and adverse effects of adding Liuwei Dihuang Pills (LDP) to Western medicine for treating diabetic nephropathy. Methods. Studies were retrieved from seven electronic databases, including PubMed, Embase, The Cochrane Library, CBM, CNKI, Chinese Scientific Journal Database (VIP), and Wanfang Data until November 2015. Study selection, data extraction, quality assessment, and data analyses were conducted according to Cochrane standards. Meta-analysis was performed on the overall therapeutic efficacy of hyperglycemia and renal functions, and the study also analyzed adverse events. Results. A total of 1,275 patients from 18 studies were included. The methodological quality of these included trials was generally low. We found that adding LDP can lower patients’ FBG (MD: −0.36 [−0.46, −0.25], 𝑃 < 0.00001), PBG (MD: −1.10 [−1.35, −0.85], 𝑃 < 0.00001), and HbA1c (MD: −0.14 [−0.49, 0.21], 𝑃 = 0.43). There were also improvements in lowering patients’ BUN (MD: −0.67 [−0.89, −0.45], 𝑃 < 0.00001), SCr (MD: −0.96 [−1.53, −0.39], 𝑃 < 0.00001), 24 h UTP (SMD: −1.26 [−2.38, −0.15], 𝑃 < 0.00001), UAER (MD: −26.18 [−27.51, −24.85], 𝑃 < 0.00001), and UmAlb (SMD: −1.72 [−2.67, −0.77], 𝑃 < 0.00001). Conclusion. There is encouraging evidence that adding LDP to Western medicine might improve treatment outcomes of diabetic nephropathy, including hyperglycemia and renal functions. However, the evidence remains weak. More rigorous high-quality trials are warranted to substantiate or refute the results. 1. Introduction Diabetic nephropathy (DN) is a widely recognized microvascular complication of diabetes and almost the leading cause of end-stage kidney failure worldwide responsible for morbidity and mortality [1]. If the damage to the kidney and proteinuria is irreversible, it will evolve into End-Stage Renal Disease. However, exact pathogenesis of DN is still unclear and it is difficult for us to cure DN. At present diet management, control of blood pressure and blood sugar, and blood fat treatment are the foundation treatment for DN. Furthermore, an adequate control of high blood pressure and treatment of microalbuminuria are the major therapeutic targets [2]. To achieve adequate blood pressure control, a combination therapy with different classes of antihypertensive agents is often necessary, especially including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) [3]. ACEIs and ARBs have been demonstrated to protect renal function of DN but are not enough to delay or retard the progression of DN; therefore, exploring feasible drugs is the hotspot of medical research at present. Currently, with increasing application of complementary and alternative medicine (CAM) worldwide, traditional Chinese medicine (TCM) has become more popular and has drawn more attention [4–7]. TCM has lots of advantages over the conventional medical approaches in the prevention of diabetic complications because of less toxicity and/or side effects [8–10]. TCM is becoming increasingly popular and widely used among patients with DN [11]. Liuwei Dihuang Pills (LDP), a traditional Chinese herbal formula containing six commonly used herbs (Rehmannia 2 Evidence-Based Complementary and Alternative Medicine glutinosa, Cornus officinalis Sieb., Common Yam Rhizome, Alisma orientalis, Tree Peony Bark, and Poria cocos), are widely used to DN-related symptoms in clinical practice for centuries in China. Three of the six ingredients in the formula are nutrients, while the other three facilitate drainage, enrich yin, nourish the kidney (Shen), and thereby address the root cause of diabetes according to the Chinese medicine theory [12]. Currently, LDP combined with Western medicine has been widely used as an alternative and effective method to treat or prevent diabetic nephropathy in China. Up to now, lots of studies have been published about the effects of LDP combined with conventional drugs for diabetic nephropathy. It is necessary for us to compare the effect of such combinations to the use of Western medicine alone. This report aims to evaluate the beneficial and adverse effects of LDP combined with conventional drugs for the treatment of DN in randomized trials. Identification 2.1. Database and Search Strategies. Initial searches were performed by 2 authors independently. We selected all the clinical trials about LDP used for treating DN in the Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang Data, Chinese Biomedical Literature Database (CBM), PubMed, Embase, and the Cochrane Central Register of Controlled Trials in The Cochrane Library. All of those searches ended on November 30, 2015. Search terms used were diabetes mellitus, DN, and chronic kidney impairment, combined with LDP. Additionally, we checked bibliographies of retrieved articles and prior reviews on the subject for additional references. We contacted the authors of included trials for missing information when necessary. 2.2. Inclusion and Exclusion Criteria. All the randomized controlled trials (RCTs) based on LDP combined with Western drugs or Western conventional therapeutics compared with corresponding Western drugs or Western conventional therapeutics in patients with DN were included. No restrictions on language, population characteristics, or publication type were enforced. The primary outcome measure that the current study examined was the overall clinical efficacy of LDP for hyperglycemia and impairments of renal functions. A secondary outcome that was assessed was frequency of adverse events. Articles that duplicated the same groups of participants in another publication were excluded. 2.3. Data Extraction and Quality Assessment. Two authors conducted the literature searching (Q. H. Wang and Y. X. Yi), two conducted study selection (Q. H. Wang and S. H. Wang), and two conducted data extraction (...truncated)