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Journal of Taibah University Medical... Jun 2023Diabetic nephropathy causes cardiovascular complications among individuals with diabetes which results in decreased kidney function and overall physical decline. The... (Review)
Review
Diabetic nephropathy causes cardiovascular complications among individuals with diabetes which results in decreased kidney function and overall physical decline. The objective of this systematic review was to determine effects of exercise on various renal function parameters amond individuals with type 2 diabetes and nephropathy. It was registered with PROSPERO (CRD42020198754). Total 6 databases (PubMed/Medline, Scopus, Web of Science, CINAHL, ProQuest, and Cochrane) were searched. Among 1734 records, only four randomized controlled trials were included. The review included a total of 203 participants (103 in the intervention group and 100 in the control/standard group) with type 2 diabetic nephropathy or stage 2,3, or 4 of chronic kidney disease. The meta-analysis showed no effects of exercise on serum creatinine, serum cystatin c and varied eGFR equations. However, exercise decreased urinary albumin to creatinine ratio, urinary protein to creatinine ratio, serum urea nitrogen, creatinine clearance, and urinary protein excretion while increasing urea clearance. Limited evidence on the reno-protective role of exercise demands future research in this direction.
PubMed: 36818178
DOI: 10.1016/j.jtumed.2022.11.002 -
Rheumatology International Aug 2011Lupus protein-losing enteropathy (LUPLE) is a well reported but a rare manifestation of systemic lupus erythematosus (SLE). The main objectives of this study are to... (Review)
Review
Lupus protein-losing enteropathy (LUPLE) is a well reported but a rare manifestation of systemic lupus erythematosus (SLE). The main objectives of this study are to raise awareness of LUPLE that can be easily missed by internist, rheumatologist, gastroenterologist and nephrologist, and then to be considered in any patient with unexplained edema, ascites, and hypoalbuminemia. A systematic review was performed with 112 patients who met the eligibility criteria and were critically appraised. The LUPLE was ultimately diagnosed by either Tc-(99m) albumin scintography ((99m)Tc-HAS) or fecal alpha-1-antitrypsin clearance test. Clinical features of patients, at the time of LUPLE diagnosis, were as follows: age was 34 ± 14.2 years; the female to male ratio was 5.8:1; the mean time to development of LUPLE after diagnosis of SLE was 4.19 ± 4.7 years. There was a predominance of Asian (64.7%) while 29.5% were white or Hispanic patients. Eighty percent had peripheral edema, 48% had ascites, 38% had pleural effusion, and 21% had pericardial effusion. Forty-six percent had diarrhea, 27% had abdominal pain, 22% had nausea, and 19% had vomiting. Hypoalbuminemia was the most common characteristic laboratory finding (96%). A 24-h urine protein was less than 0.5 gm in (71%). Almost all patients (96%) had positive ANA with predominant speckled patterns (55%) and hypocomplementemia (79%). Colonoscopy showed mucosal thickening in 44% of patients, and the majority of patients (52%) revealed no abnormalities; on the other hand, intestinal histology either revealed mucosal edema, inflammatory cell infiltrate, lymphangiectasia, mucosal atrophy or vasculitis in 80% of patients. All patients were started on steroids. Thirty-four percent responded to steroids alone. Sixty-six percent were started with other immunosuppressive therapies, which include cyclophosphamide (46%), azathioprine (33%), and a combination of cyclophosphamide and azathioprine (7%). A few reported cases responded to either cyclosporine or etanercept. Prognosis was very good with steroids combined with immunosuppressive therapy. This is the first systematic review of LUPLE and should be considered as an etiology of unidentified edema, ascites, and hypoalbuminemia.
Topics: Adult; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Male; Protein-Losing Enteropathies
PubMed: 21344315
DOI: 10.1007/s00296-011-1827-9 -
Medicine Feb 2021The combination of Traditional Chinese medicine and Western medicine (TCM+WM) has been widely used in the treatment of glomerulosclerosis, but the results are still... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The combination of Traditional Chinese medicine and Western medicine (TCM+WM) has been widely used in the treatment of glomerulosclerosis, but the results are still controversial. This study will assess the clinical efficacy of TCM+WM for glomerulosclerosis and provide evidence-based medical data via meta-analysis.
METHOD
The MEDLINE, EMBASE, PubMed, Cochrane Central Registry of Controlled Trials, and multiple Chinese databases (Wan Fang, CNKI, and VIP) were searched for randomized controlled trials (RCT) that compared the effects of WM and TCM+WM. Review Manager 5.3 software was used for the meta-analysis of selected studies, and appropriate tests were performed to determine the quality, heterogeneity and sensitivity of these studies.
RESULTS
Sixteen RCTs met the inclusion criteria and were selected for the analysis. Compared with the placebo or WM-treated glomerulosclerosis patients, TCM+WM intervention significantly improved renal function indices including 24-hour urine protein quantity (24 h U-Pro), serum creatinine (Scr), blood urea nitrogen (BUN), creatinine clearance (Ccr). In addition, the serum albumin (ALB), triglyceride (TG), and cholesterol (CHOL) levels were also significantly improved (P < .05) in patients receiving the combination therapy. Finally, the combination of TCM+WM reduced the indices of glomerulosclerosis more effectively compared with WM alone.
CONCLUSION
The combination of TCM+WM can significantly improve the renal function and prognosis of patients with glomerulosclerosis.
Topics: Combined Modality Therapy; Drugs, Chinese Herbal; Glomerulosclerosis, Focal Segmental; Humans; Medicine, Chinese Traditional; Randomized Controlled Trials as Topic
PubMed: 33607841
DOI: 10.1097/MD.0000000000024799 -
The Cochrane Database of Systematic... Dec 2014Cordyceps sinensis (Cordyceps, Dong Chong Xia Cao), a herbal medicine also known as Chinese caterpillar fungus, is one of the most commonly used ingredients in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cordyceps sinensis (Cordyceps, Dong Chong Xia Cao), a herbal medicine also known as Chinese caterpillar fungus, is one of the most commonly used ingredients in traditional Chinese medicine for the treatment of people with chronic kidney disease (CKD).
OBJECTIVES
This review aimed to evaluate the therapeutic effects and potential adverse effects of Cordyceps sinensis for the treatment of people with CKD.
SEARCH METHODS
We searched the Cochrane Renal Group's Specialised Register to 14 April 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched CINAHL, AMED, Current Controlled Trials, OpenSIGLE, and Chinese databases including CBM, CMCC, TCMLARS, Chinese Dissertation Database, CMAC and Index to Chinese Periodical Literature.
SELECTION CRITERIA
Randomised and quasi-randomised trials comparing Cordyceps or its products with placebo, no treatment, or conventional treatment were considered for inclusion in the review.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed data quality and extracted data. Statistical analyses were performed using the random-effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS
We included 22 studies that involved 1746 participants. Among people with CKD who were not receiving dialysis, Cordyceps preparations were found to significantly decrease serum creatinine (14 studies, 987 participants): MD -60.76 μmol/L, 95% CI -85.82 to -35.71); increase creatinine clearance (6 studies, 362 participants): MD 9.22 mL/min, 95% CI 3.10 to 15.34) and reduce 24 hour proteinuria (4 studies, 211 participants: MD -0.15 g/24 h, 95% CI -0.24 to -0.05). However, suboptimal reporting and flawed methodological approaches meant that risk of bias was assessed as high in four studies and unclear in 18 studies, and hence, these results need to be interpreted with caution.
AUTHORS' CONCLUSIONS
We found that Cordyceps preparation, as an adjuvant therapy to conventional medicine, showed potential promise to decrease serum creatinine, increase creatine clearance, reduce proteinuria and alleviate CKD-associated complications, such as increased haemoglobin and serum albumin. However, definitive conclusions could not be made because of the low quality of evidence.
Topics: Cordyceps; Creatine; Creatinine; Humans; Phytotherapy; Proteinuria; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic
PubMed: 25519252
DOI: 10.1002/14651858.CD008353.pub2 -
Clinical Nutrition (Edinburgh, Scotland) Feb 2016Recent studies have demonstrated mixed results on the effects of soy intake in patients with CKD, and this have not been systematically analyzed. We conducted this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Recent studies have demonstrated mixed results on the effects of soy intake in patients with CKD, and this have not been systematically analyzed. We conducted this meta-analysis to identify and evaluate the effects of soy protein intake in patients with CKD.
METHODS
A comprehensive search of Medline, Embase and the Cochrane Database of Systematic Reviews was performed in December 2013 and updated in April 2014 for any new trials. Randomized trials designed to evaluate the effects of dietary soy in patients with CKD were collected. Weighted mean effect sizes were calculated for net changes using random-effect or fixed-effect model. All statistical analysis were calculated by RevMan software 5.2 available free from the Cochrane Collaboration.
RESULTS
12 studies (280 participants) were included. And we found that dietary soy was associated with significant decrease of serum creatinine, serum phosphorus, CRP (C reactive protein)and proteinuria in the predialysis subgroup. The mean difference was -0.05 mg/dL (95% CI: -0.10, -0.00 mg/dL; P = 0.04) for serum creatinine, -0.13 mg/dL (95% CI: -0.26, -0.01 mg/dL; P = 0.04) for serum phosphorus, -0.98 mg/L (95% CI: -1.25, -0.71 mg/L; P < 0.00001) for CRP, and -0.13 mg/d (95% CI: -0.18, -0.08 mg/d; P < 0.00001) for proteinuria. We did not find any significant change in serum phosphorus, CRP in the dialysis subgroup. Blood urea nitrogen (BUN) was reduced with statistical significance in the soy-treated group compared with control when the predialysis and dialysis subgroup were analyzed as a whole. The pooled estimated effects of change for BUN was -0.37 mg/dL (95% CI: -6.03, -0.11 mg/dL; P = 0.04). No significant change was detected in creatinine clearance, glomerular filtration rate, serum albumin, body weight and body mass index(BMI).
CONCLUSIONS
Soy protein containing isoflavones intake significantly decreased serum creatinine, serum phosphorus, CRP and proteinura in predialysis patients, while no significant change was found in creatinine clearance and glomerular filtration rate. We also found that soy protein intake could maintain the nutritional status in dialysis patients, though no significant change in CRP, BUN, and serum phosphorus was detected. Future large, long-term RCTs are still needed to clarify the effects of soy protein intake in patients with CKD.
Topics: Blood Urea Nitrogen; Body Mass Index; Body Weight; C-Reactive Protein; Creatinine; Glomerular Filtration Rate; Humans; Isoflavones; Phosphorus; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Serum Albumin; Soybean Proteins
PubMed: 25882339
DOI: 10.1016/j.clnu.2015.03.012 -
PloS One 2014High blood pressure can cause kidney damage, which can increase blood pressure, leading to a vicious cycle. It is not clear whether the protective effects of T-type... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
High blood pressure can cause kidney damage, which can increase blood pressure, leading to a vicious cycle. It is not clear whether the protective effects of T-type calcium channel blockers (T-type CCBs) on renal function are better than those of L-type CCBs or renin-angiotensin system (RAS) antagonists in patients with hypertension.
METHODS AND FINDINGS
PUBMED, MEDLINE, EMBASE, OVID, Web of Science, Cochrane, CNKI, MEDCH, VIP, and WANFANG databases were searched for clinical trials published in English or Chinese from January 1, 1990, to December 31, 2013. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated and reported. A total of 1494 reports were collected, of which 24 studies with 1,696 participants (including 809 reports comparing T-type CCBs versus L-type CCBs and 887 reports comparing T-type CCB versus RAS antagonists) met the inclusion criteria. Compared with L-type CCBs, T-type CCBs resulted in a significant decline in aldosterone (mean difference = -15.19, 95% CI -19.65 - -10.72, p<1×10(-5)), proteinuria (mean difference = -0.73, 95% CI -0.88 - -0.57, p<1×10(-5)), protein to creatinine ratio (mean difference = -0.22, 95% CI -0.41 - -0.03, p = 0.02), and urinary albumin to creatinine ratio (mean difference = -55.38, 95% CI -86.67 - -24.09, p = 0.0005); no significant difference was noted for systolic blood pressure (SBP) (p = 0.76) and diastolic blood pressure (DBP) (p = 0.16). The effects of T-type CCBs did not significantly differ from those of RAS antagonists for SBP (p = 0.98), DBP (p = 0.86), glomerular filtration rate (p = 0.93), albuminuria (p = 0.97), creatinine clearance rate (p = 0.24), and serum creatinine (p = 0.27) in patients with hypertension.
CONCLUSION
In a pooled analysis of data from 24 studies measuring the effects of T-type CCBs on renal function and aldosterone, the protective effects of T-type CCBs on renal function were enhanced compared with L-type CCBs but did not differ from RAS antagonists. Their protective effects on renal function were independent of blood pressure.
Topics: Adult; Aged; Aldosterone; Calcium Channel Blockers; Calcium Channels, L-Type; Calcium Channels, T-Type; Case-Control Studies; Humans; Hypertension; Middle Aged; Proteinuria
PubMed: 25330103
DOI: 10.1371/journal.pone.0109834 -
Renal Failure Jun 2014Vitamin E-coated dialyzer may have an effect on oxidative stress and inflammation status in hemodialysis (HD) patients. Therefore, we performed a systematic review to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vitamin E-coated dialyzer may have an effect on oxidative stress and inflammation status in hemodialysis (HD) patients. Therefore, we performed a systematic review to assess the anti-oxidation and anti-inflammatory effects of vitamin E-coated dialyzer in HD patients.
METHODS
The randomized controlled trials (RCTs) and quasi-RCTs of vitamin E-coated dialyzer versus conventional dialyzer for HD patients were searched from multiple databases. We screened relevant studies according to predefined inclusion criteria and performed meta-analyses using RevMan 5.1 software.
RESULTS
Meta-analysis showed vitamin E-coated dialyzer therapy could significantly decrease the serum thiobarbituric acid reacting substances (TBARS) (SMD, -0.95; 95% CI, -1.28 to -0.61; p < 0.00001), oxLDL (SMD, -0.61; 95% CI, -1.04 to -0.19; p = 0.005), interleukin-6 (IL-6) (SMD, -0.65; 95% CI, -0.97 to -0.32; p < 0.0001) and C-reactive protein (CRP) levels (SMD, -0.46; 95% CI, -0.87 to -0.05; p = 0.03) compared with that of the control group. However, vitamin E-coated dialyzer did not result in increasing the total antioxidant status (TAS) (SMD, 0.23; 95% CI, -0.16 to 0.61; p = 0.25) and the fractional clearance of urea index (Kt/v) levels (MD, -0.07; 95% CI, -0.14 to 0.00; p = 0.06), in addition, there was no significant difference in plasma superoxide dismutase (SOD) level compared with that of the conventional dialyzer & oral vitamin E group (SMD, 0.28; 95% CI, -0.20 to 0.75; p = 0.26).
CONCLUSIONS
Vitamin E-coated dialyzer can reduce the oxidative stress and inflammation status reflected by the decreasing of serum TBARS, oxLDL, CRP, and IL-6 levels, and this new dialyzer does not affect the dialysis adequacy.
Topics: Antioxidants; C-Reactive Protein; Humans; Inflammation; Interleukin-6; Kidney Failure, Chronic; Kidneys, Artificial; Oxidative Stress; Publication Bias; Randomized Controlled Trials as Topic; Renal Dialysis; Vitamin E
PubMed: 24575826
DOI: 10.3109/0886022X.2014.890858 -
European Journal of Clinical... Jun 2024Despite being clinically utilized for the treatment of infections, the limited therapeutic range of polymyxin B (PMB), along with considerable interpatient variability... (Review)
Review
BACKGROUND AND OBJECTIVES
Despite being clinically utilized for the treatment of infections, the limited therapeutic range of polymyxin B (PMB), along with considerable interpatient variability in its pharmacokinetics and frequent occurrence of acute kidney injury, has significantly hindered its widespread utilization. Recent research on the population pharmacokinetics of PMB has provided valuable insights. This study aims to review relevant literature to establish a theoretical foundation for individualized clinical management.
METHODS
Follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Pop-PK studies of PMB were searched in PubMed and EMBASE database systems from the inception of the database until March 2023.
RESULT
To date, a total of 22 population-based studies have been conducted, encompassing 756 subjects across six different countries. The recruited population in these studies consisted of critically infected individuals with multidrug-resistant bacteria, patients with varying renal functions, those with cystic fibrosis, kidney or lung transplant recipients, patients undergoing extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT), as well as individuals with obesity or pediatric populations. Among these studies, seven employed a one-compartmental model, with the range of typical clearance (CL) and volume (Vc) being 1.18-2.5L /h and 12.09-47.2 L, respectively. Fifteen studies employed a two-compartmental model, with the ranges of the clearance (CL) and volume of the central compartment (Vc), the volume of the peripheral compartment (Vp), and the intercompartment clearance (Q) were 1.27-8.65 L/h, 5.47-38.6 L, 4.52-174.69 L, and 1.34-24.3 L/h, respectively. Primary covariates identified in these studies included creatinine clearance and body weight, while other covariates considered were CRRT, albumin, age, and SOFA scores. Internal evaluation was conducted in 19 studies, with only one study being externally validated using an independent external dataset.
CONCLUSION
We conclude that small sample sizes, lack of multicentre collaboration, and patient homogeneity are the primary reasons for the discrepancies in the results of the current studies. In addition, most of the studies limited in the internal evaluation, which confined the implementation of model-informed precision dosing strategies.
Topics: Humans; Polymyxin B; Anti-Bacterial Agents; Models, Biological; Extracorporeal Membrane Oxygenation; Critical Illness
PubMed: 38483544
DOI: 10.1007/s00228-024-03666-w -
Chinese Medical Journal Jan 2023Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The aim of this systematic review was to investigate the efficacy of HCO membranes regarding the clearance of inflammation-related mediators, β2-microglobulin and urea; albumin loss; and all-cause mortality in patients requiring RRT.
METHODS
We searched all relevant studies on PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, with no language or publication year restrictions. Two reviewers independently selected studies and extracted data using a prespecified extraction instrument. Only randomized controlled trials (RCTs) were included. Summary estimates of standardized mean differences (SMDs) or weighted mean differences (WMDs) and risk ratios (RRs) were obtained by fixed-effects or random-effects models. Sensitivity analyses and subgroup analyses were performed to determine the source of heterogeneity.
RESULTS
Nineteen RCTs involving 710 participants were included in this systematic review. Compared with HF membranes, HCO membranes were more effective in reducing the plasma level of interleukin-6 (IL-6) (SMD -0.25, 95% confidence interval (CI) -0.48 to -0.01, P = 0.04, I2 = 63.8%); however, no difference was observed in the clearance of tumor necrosis factor-α (TNF-α) (SMD 0.03, 95% CI -0.27 to 0.33, P = 0.84, I2 = 4.3%), IL-10 (SMD 0.22, 95% CI -0.12 to 0.55, P = 0.21, I2 = 0.0%), or urea (WMD -0.27, 95% CI -2.77 to 2.23, P = 0.83, I2 = 19.6%). In addition, a more significant reduction ratio of β 2 -microglobulin (WMD 14.8, 95% CI 3.78 to 25.82, P = 0.01, I2 = 88.3%) and a more obvious loss of albumin (WMD -0.25, 95% CI -0.35 to -0.16, P < 0.01, I2 = 40.8%) could be observed with the treatment of HCO membranes. For all-cause mortality, there was no difference between the two groups (risk ratio [RR] 1.10, 95% CI 0.87 to 1.40, P = 0.43, I2 = 0.0%).
CONCLUSIONS
Compared with HF membranes, HCO membranes might have additional benefits on the clearance of IL-6 and β 2-microglobulin but not on TNF-α, IL-10, and urea. Albumin loss is more serious with the treatment of HCO membranes. There was no difference in all-cause mortality between HCO and HF membranes. Further larger high-quality RCTs are needed to strengthen the effects of HCO membranes.
Topics: Humans; Albumins; Interleukin-10; Interleukin-6; Renal Replacement Therapy; Tumor Necrosis Factor-alpha
PubMed: 36848147
DOI: 10.1097/CM9.0000000000002150 -
Surgery For Obesity and Related... Dec 2016The impact of bariatric surgery on renal functions in patients with type 2 diabetes (T2D) remains uncertain. (Review)
Review
BACKGROUND
The impact of bariatric surgery on renal functions in patients with type 2 diabetes (T2D) remains uncertain.
OBJECTIVES
To assess the impact of bariatric surgery on renal functions in patients with T2D.
SETTING
Systemic review and meta-analysis of randomized trials and observational studies.
METHODS
We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 3, 2016. We included studies assessing bariatric surgery for renal functions in patients with T2D. We analyzed changes in renal functions before and after surgery and compared outcomes between surgeries versus nonsurgical treatments.
RESULTS
Twenty-nine studies (4 randomized controlled trials, 5 cohort studies, 20 before-and-after studies; all at moderate to high risk of bias) were eligible, involving 18,172 patients. Analyses of changes before and after surgeries suggested a significantly lower proportion of albuminuria (difference -21.2%, 95% confidence interval [CI] -28.8% to -13.5%), 24-hour urine albumin excretion rate (weighted mean difference -48.78 mg/24 hr, 95% CI -75.32 to -22.24) and urine albumin-to-creatinine ratio (uACR) (weighted mean difference -16.10 mg/g, 95% CI -22.26 to -9.94) after surgery. Compared with nonsurgical treatment, bariatric surgery was associated with a statistically lower level of uACR and lower risk of new-onset albuminuria (odds ratio .18, 95% CI .03-.99 from randomized controlled trials). The effects on glomerular filtration rate, serum creatinine, creatinine clearance, and risk of end-stage renal disease were not statistically significant.
CONCLUSIONS
Low-quality evidence suggests that bariatric surgery possibly improves albuminuria and uACR in patients with T2D; its effects on other outcomes were uncertain. Well-conducted, adequately powered, randomized controlled trials are warranted to examine the effect of bariatric surgery on renal functions in the T2D population.
Topics: Adult; Albuminuria; Bariatric Surgery; Creatinine; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Obesity, Morbid; Observational Studies as Topic; Randomized Controlled Trials as Topic
PubMed: 27421689
DOI: 10.1016/j.soard.2016.05.003