Objective To assess the efficacy and safety of prescribing medicinal charcoal for treatment of adult chronic kidney disease. Methods We searched the Cochrane Controlled Trial Register (The Cochrane Library Issue 1, 2009), MEDLINE (1950 to January 2009), EMbase (1980 to January 2009), and Chinese Biomedical Database (1977 to January 2009) to screen randomized controlled trials (RCTs) concerning use of medicinal charcoal for treatment of adult chronic kidney disease. We evaluated the bias risk of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.2.The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Seven trials involving 347 patients met the criteria. Meta-analysis showed: (1) Medicinal charcoal was better than routine treatment on the improvement of blood urea nitrogen [MD= –0.69, 95%CI (–1.13, –0.24), P=0.002], serum creatinine [MD= – 0.51, 95%CI (–0.94, – 0.08), P=0.02] and the mean change of glomerular filtration rate per month (Plt;0.001). Compared with routine treatment, medicinal charcoal had similar effects on the improvement of 24 hours urinary protein and the mean change of blood pressure; (2) Compared with placebo, and medicinal charcoal was not superior to placebo in improving the incidence of end stage kidney diseases, serum creatinine, creatinine clearance rate, 24 hour urinary protein (Pgt;0.05); (3) Adverse events with constipation, flatulenceand nausea occurred to medicinal charcoal groups. Conclusion Overall, the evidence is not b enough, and more large, high-quality randomized controlled trials are needed to confirm or refute the available evidence.
Objective To assess the clinical efficacy of Cordyceps sinensis in the treatment of chronic kidney diseases. Methods Randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) were identified from MEDLINE (1996 to Oct. 2005), EMbase (1984 to Oct. 2005), The Cochrane Central Register of controlled Trials (Issue 3, 2005) and CBMdisc (1978 to Oct. 2005). We also handsearched related published and unpublished data and their references. Data were extracted and evaluated by two reviewers independently with a designed extraction form. RevMan4.2.7 software was used for data analysis. Results One RCT and 5 quasi-RCTs involving 434 patients were included. Results of meta-analysis were presented as follows: ① Response rate: five studies showed that, compared with the blank control group, significant differences were observed after the treatment with Cordyceps (RR 2.13, 95%CI 1.06 to 4.26); one study showed that there was no difference between Cordyceps and Shenyankangfu tablet (RR 2.17, 95%CI 0.73 to 6.460). ② Total effective rate: five studies showed that, compared with the blank control group, significant differences were observed after the treatment with Cordyceps (RR1.94, 95 %CI 1.14 to 3.30); one study showed that there was no difference between Cordyceps and Shenyankangfu tablet (RR 1.39, 95%CI 0.89 to 2.16). ③ Adverse reactions: adverse reactions were rare only with mild symptoms. Conclusions Cordyceps sinensis may improve the response rate and total effective rate of chronic kidney diseases. More high quality trials are required.
【摘要】 目的 探讨六味地黄丸对糖尿病合并高血压病所致慢性肾脏疾病（chronic kidney disease，CKD）患者肾损害及胰岛素抵抗的影响。 方法 收集2008年7月1日-2010年7月1日在成都市第五人民医院住院部及门诊就诊的120例糖尿病合并高血压病患者相关资料，随机分为对照组和治疗组各60例，对照组给予西医治疗，治疗组在西医治疗的基础上加用六味地黄丸，12周为1个疗程。观察治疗前后尿白蛋白∕尿肌酐（ACR），内生肌酐清除率（Ccr）及胰岛素抵抗指数（HOMA-IR）、C反应蛋白（CRP）、血脂等指标的变化。 结果 治疗后治疗组与对照组比较，ACR（P=0.012）、血清CRP（P=0.000）和低密度脂蛋白（P=0.014）差异有统计学意义。HOMA-IR治疗前后结果差异有统计学意义（Plt;0.05），但与对照组比较差异无统计学意义（Pgt;0.05）。 结论 六味地黄丸可改善肾损害实验室指标，改善胰岛素抵抗，减轻体内炎性反应，改善脂代谢异常。【Abstract】 Objective To investigate the efficacy of Liuwei Dihuang pill on patients with chronic kidney disease (CKD) induced by diabetes mellitus and hypertensive diseases in terms of renal injury and insulin resistance. Methods We collected the clinical data of 120 patients with diabetes mellitus and hypertensive diseases in the Fifth People’s Hospital of Chengdu from July 1, 2008 to July 1, 2010, and randomly divided them into two groups. In the control group, patients only received therapy of western medicine, while for patients in the treatment group, Liuwei Dihuang pills were added on the basis of western medicine treatment with a treatment course of 12 weeks. Before and after the treatment, urinary albumin / urinary creatinine (ACR), creatinine clearance rate (Ccr) and insulin resistance index (HOMA-IR), C-reactive protein (CRP), and lipids were evaluated and compared. Results After treatment, ACR (P=0.012), serum CRP (P=0.000) and low-density lipoproteins (LDL) (P=0.014) for the treatment group were significantly different from those for the control group. HOMA-IR for the treatment group before and after the treatment was significantly different (Plt;0.05), while there was no statistical difference between the two groups in HOMA-IR (Pgt;0.05). Conclusion Kidney-nourishing therapy with Liuwei Dihuang pill can improve the laboratory indicators of renal injury or insulin resistance, reduce the inflammatory response in vivo, and ameliorate disorders of lipid metabolism.
ObjectiveTo systematically review the impact of chronic kidney disease (CKD) at different stages on prognosis of transcatheter aortic valve replacement (TAVR).MethodsDatabases including PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, Wanfang and the Chinese Biomedical Literature Database (CBM) were searched by computer to collect cohort studies on impact of different stages of CKD on prognosis of TAVR from inception to July 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using Stata 15.0 software. Risk of study bias was assessed using the Newcastle-Ottawa Scale (NOS).ResultsA total of 17 cohort studies were included with NOS score≥6 points. The results of meta-analysis indicated that: compared with the patients without CKD, all-cause mortality of CKD stage 3 patients at 30 day (RR=1.29, 95%CI 1.22-1.37, P<0.001) and 1 year (RR=1.24, 95%CI 1.19-1.28, P<0.001), all-cause mortality of CKD stage 4 patients at 30 day (RR=2.10, 95%CI 1.90-2.31, P<0.001) and 1 year (RR=1.89, 95%CI 1.62-2.19, P<0.001), and all-cause mortality of CKD stage 5 patients at 30 day (RR=2.22, 95%CI 1.62-2.19, P<0.001) and 1 year (RR=2.24, 95%CI 1.75-2.87, P<0.001) were significantly increased and were associated with the severity of CKD. The occurrence rates of 1-year cardiovascular mortality, postoperative acute kidney injury and bleeding events were all higher in patients with CKD.ConclusionCKD at stages 3, 4 and 5 is associated with increased all-cause mortality after TAVR, and the higher the stage of CKD is, the higher the risk of all-cause mortality at 30-day and 1-year follow-up is. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.