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Frontiers in Endocrinology 2024To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary intervention and diabetic nephropathy (DN). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary intervention and diabetic nephropathy (DN).
METHODS
We conducted an umbrella review of existing meta-analyses of randomized controlled trials (RCTs) that focused on the effects of dietary intervention on DN incidence. The literature was searched via PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. According to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), evidence of each outcome was evaluated and graded as "high", "moderate", "low" or "very low" quality to draw conclusions. Additionally, we classified evidence of outcomes into 4 categories.
RESULTS
We identified 36 meta-analyses of RCTs and 55 clinical outcomes of DN from 395 unique articles. Moderate-quality evidence suggested that probiotic supplementation could significantly improve blood urea nitrogen (BUN), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in DN patients. Low-quality evidence indicated that probiotic supplementation significantly improved the serum creatinine concentration, urinary albumin-creatinine ratio (UACR), fasting blood glucose (FBG), HbA1c and high-density lipoprotein cholesterol (HDL-C) in DN patients. In addition, low-quality evidence suggested that a salt restriction diet could significantly improve the creatinine clearance rate (CrCl) in patients with DN. Low-quality evidence suggested that vitamin D supplementation could significantly improve the UACR in patients with DN. In addition, low-quality evidence has indicated that soy isoflavone supplementation could significantly improve BUN, FBG, total cholesterol (TC), triglyceride (TG) and LDL-C levels in patients with DN. Furthermore, low-quality evidence suggested that coenzyme Q10 supplementation could significantly improve HbA1c, TC and HDL-C in patients with DN, and dietary polyphenols also significantly improved HbA1c in patients with DN. Finally, low-quality evidence suggested that supplementation with antioxidant vitamins could significantly improve the serum creatinine concentration, systolic blood pressure, and HbA1c level in patients with DN. Given the small sample size, all significantly associated outcomes were evaluated as class IV evidence.
CONCLUSION
Moderate to low amounts of evidence suggest that supplementation with probiotics, vitamin D, soy isoflavones, coenzyme Q10, dietary polyphenols, antioxidant vitamins, or salt-restricted diets may significantly improve clinical outcomes in patients with DN.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024512670.
Topics: Humans; Diabetic Nephropathies; Dietary Supplements; Meta-Analysis as Topic; Probiotics; Randomized Controlled Trials as Topic; Systematic Reviews as Topic
PubMed: 38742202
DOI: 10.3389/fendo.2024.1385872 -
Nutrition Reviews Nov 2022Polyphenols have antioxidant, anti-inflammatory, and anti-glycation properties. (Meta-Analysis)
Meta-Analysis
Effects of dietary polyphenols in the glycemic, renal, inflammatory, and oxidative stress biomarkers in diabetic nephropathy: a systematic review with meta-analysis of randomized controlled trials.
CONTEXT
Polyphenols have antioxidant, anti-inflammatory, and anti-glycation properties.
OBJECTIVE
To assess the effects of dietary polyphenols, from food sources or supplements, on the anthropometric, glycemic, renal, inflammatory, and oxidative stress markers in adults with diabetic nephropathy (DN).
DATA SOURCES
Systematic searches for randomized clinical trials were performed in MEDLINE, Embase, CENTRAL, Web of Science, LILACS, SciELO, opengrey.eu, and ClinicalTrials.gov databases until December 2021.
DATA EXTRACTION
Studies with adults with DN were included. Random-effects meta-analyses were conducted. Risk of bias of the studies and Grading of Recommendations, Assessment, Development, and Evaluation assessment were carried out.
DATA ANALYSIS
The searches resulted in 5614 unique occurrences, and 34 full-text articles were retrieved. Of these, 17 studies were included in the qualitative synthesis. Most of the studies used soy protein or milk (n = 5; 0.5-1 g/kg of body weight/d of soy protein, or introduction of 240 mL/d of soy milk) or turmeric/curcumin (n = 5; dose range, 80 to 1500 mg/d) as the intervention. The following outcomes were analyzed: body mass index, glycated hemoglobin (HbA1c), proteinuria, creatinine clearance, glomerular filtration rate (GFR), urinary albumin to creatinine ratio, and levels of fasting blood glucose, insulin, serum urea and creatinine, C-reactive protein, serum tumor necrosis factor-α, and serum malondialdehyde (MDA). The polyphenol intervention significantly decreased HbA1c (n = 7 studies; -0.27% [95%CI, -0.51%, -0.04%]), proteinuria (n = 5 studies; -109.10 [95%CI, -216.57, -1.63] mg/24 h), and MDA (n = 5 studies; z-score: -0.41; 95%CI, -0.71, -0.10), and significantly increased GFR (n = 7 studies; 3.65 [95%CI, 0.15-7.15] mL/min/1.73 m2). Overall, studies showed a high risk of bias, and outcomes showed a low or very-low quality in the Grading of Recommendations, Assessment, Development, and Evaluation assessment.
CONCLUSIONS
There is a clinically modest effect of dietary polyphenols intervention in HbA1c, proteinuria, GFR, MDA, and C-reactive protein levels in patients with DN. It is impossible to establish clinical recommendations, because the evidence was of' low or very-low quality and because of the heterogeneity of types and dose regimens used in the studies.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. ID245406.
Topics: Adult; Humans; Blood Glucose; Glycated Hemoglobin; Diabetic Nephropathies; Polyphenols; Creatinine; C-Reactive Protein; Soybean Proteins; Randomized Controlled Trials as Topic; Biomarkers; Oxidative Stress; Proteinuria; Diabetes Mellitus
PubMed: 35595310
DOI: 10.1093/nutrit/nuac035 -
Current Clinical Pharmacology 2020Diabetic Nephropathy is a frequent complication of diabetes mellitus due to functional and structural modifications in multiple kidney compartments. Probiotics have...
BACKGROUND
Diabetic Nephropathy is a frequent complication of diabetes mellitus due to functional and structural modifications in multiple kidney compartments. Probiotics have risen lately as a forthcoming therapeutic intervention but they have not been systematically evaluated in diabetic nephropathy so far. The aim of this systematic review was to evaluate randomized controlled trials and experimental studies assessing the effect of probiotic supplements on diabetic nephropathy.
METHODS
An extensive literature search was conducted through electronic databases (PubMed, Scopus, Cinahl and Medline) with the Medical Subject Headings and entry terms of "diabetic nephropathy", "diabetic renal disease" and "probiotics". The search yielded 116 results, 9 of which met the inclusion criteria for this systematic review.
RESULTS
Most of the microorganisms used in the studies belonged to the Lactobacillus and Bifidobacterium genus. The dosage ranged from 2×107 to 6×1010 CFU/ g. The form of the probiotics varied across the studies (capsules, sachets, soy milk, kefir and honey). The majority of the studies demonstrated the benefits of probiotic supplementation on the reduction of inflammation, oxidative stress and on the amelioration of renal function biomarkers in subjects with diabetic nephropathy. No major gastrointestinal adverse events were observed during the intervention time with probiotics.
CONCLUSION
Findings of this systematic review demonstrate the positive impact of probiotics on Diabetic Nephropathy without any major adverse events. Moreover, future larger randomized controlled trials with bigger samples and longer follow-up time are deemed necessary for further valid results on the effectiveness of probiotic supplementation on Diabetic Nephropathy.
Topics: Animals; Bifidobacterium; Diabetic Nephropathies; Humans; Inflammation; Lactobacillus; Oxidative Stress; Probiotics; Randomized Controlled Trials as Topic
PubMed: 32124701
DOI: 10.2174/1574884715666200303112753 -
World Journal of Diabetes Jun 2015To determine the prevalence and incidence of diabetic nephropathy in Africa.
AIM
To determine the prevalence and incidence of diabetic nephropathy in Africa.
METHODS
We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies. We searched PubMed-MEDLINE for all articles published in English and French languages between January 1994 and July 2014 using a predefined strategy based on the combination of relevant terms and the names of each of the 54 African countries and African sub-regions to capture the largest number of studies, and hand-searched the reference lists of retrieved articles. Included studies reported on the prevalence, incidence or determinants of chronic kidney disease (CKD) in people with diabetes within African countries.
RESULTS
Overall, we included 32 studies from 16 countries; two being population-based studies and the remaining being clinic-based surveys. Most of the studies (90.6%) were conducted in urban settings. Methods for assessing and classifying CKD varied widely. Measurement of urine protein was the most common method of assessing kidney damage (62.5% of studies). The overall prevalence of CKD varied from 11% to 83.7%. Incident event rates were 94.9% for proteinuria at 10 years of follow-up, 34.7% for end-stage renal disease at 5 years of follow-up and 18.4% for mortality from nephropathy at 20 years of follow-up. Duration of diabetes, blood pressure, advancing age, obesity and glucose control were the common determinants of kidney disease.
CONCLUSION
The burden of CKD is important among people with diabetes in Africa. High quality data from large population-based studies with validated measures of kidney function are still needed to better capture the magnitude and characteristics of diabetic nephropathy in Africa.
PubMed: 26069725
DOI: 10.4239/wjd.v6.i5.759 -
Renal Failure Dec 2021This systematic review and meta-analysis aimed to assess the predictive value of diabetic retinopathy (DR) on further diabetic nephropathy (DN) risk in patients with... (Meta-Analysis)
Meta-Analysis
The predictive value of diabetic retinopathy on subsequent diabetic nephropathy in patients with type 2 diabetes: a systematic review and meta-analysis of prospective studies.
This systematic review and meta-analysis aimed to assess the predictive value of diabetic retinopathy (DR) on further diabetic nephropathy (DN) risk in patients with type 2 diabetes (T2D) based on the prospective cohort studies. PubMed, Embase, and the Cochrane Library were systematically searched for eligible prospective cohort studies through March 2020. The predictive value of DR was assessed using sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) through the bivariate generalized linear mixed model and the random-effects model. Ten prospective cohort studies recruited 635 patients with T2D. The pooled sensitivity and specificity of DR for predicted DN were noted to be 0.64 (95% CI, 0.54-0.73) and 0.77 (95% CI, 0.60-0.88), respectively. The pooled PLR and NLR of DR for predicted DN were 2.72 (95% CI, 1.42-5.19) and 0.47 (95% CI, 0.33-0.67), respectively. The summary DOR for the relationship between DR and subsequent DN for T2D patients was 5.53 (95% CI, 2.00-15.30), and the AUC of DR for predicted DN was 0.73 (95% CI, 0.69-0.77). This study found significant associations between DR and subsequent DN risk for patients with T2D. Moreover, the predictive value of DR on subsequent DN risk was relatively lower.
Topics: Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Retinopathy; Humans; Prospective Studies; ROC Curve; Sensitivity and Specificity
PubMed: 33478336
DOI: 10.1080/0886022X.2020.1866010 -
Immunology Letters Jun 2017The aim of this study was to investigate whether the concentrations of serum tumor necrosis factor-α (TNF-α), a pro-inflammatory cytokine, increased in type 2 diabetes... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this study was to investigate whether the concentrations of serum tumor necrosis factor-α (TNF-α), a pro-inflammatory cytokine, increased in type 2 diabetes mellitus (T2DM) and type 2 diabetic nephropathy (T2DN) patients.
METHODS
The four databases (PubMed, CNKI, WanFang and Chinese-Cqvip) were searched from Jan 1, 1999 to October 1, 2016 for all clinical case-control studies about the serum TNF-α concentrations in T2DM and T2DN patients. All relevant data were extracted from published reports. The meta-analysis was performed to compare the changes of serum TNF-α concentrations of T2DN and T2DM patients in Eastern and Western with healthy controls. We further evaluated concentrations of serum TNF-α in T2DN patients with mincroalbuminuria or macroalbuminuria. Random-effects models were adopted to assess the pooling data among various variations.
RESULTS
In total of 6 studies (744 patients and 277 healthy controls) were included in this study. Compared with healthy controls (both p<0.01), the groups of different albuminuria levels and ethnicities both showed that the serum TNF-α levels were significantly elevated in T2DN patients as well as in eastern T2DN patients (p=0.001), but not significant changed in western T2DN patients (p=0.081). The results were stable through sensitivity analysis and no significant publications bias existed in this meta-analysis.
CONCLUSIONS
Serum TNF-α concentrations are obviously increased in T2DN and T2DM patients, but higher in T2DN patients, suggesting an elevated inflammatory burden in T2DN patients.
Topics: Albuminuria; Animals; Biomarkers; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Humans; Risk; Tumor Necrosis Factor-alpha
PubMed: 28414180
DOI: 10.1016/j.imlet.2017.04.003 -
Frontiers in Pharmacology 2020Salvianolate, a compound mainly composed of salvia magnesium acetate, is extracted from the Chinese herb . Because of its biological activity, easy quality control and...
BACKGROUND
Salvianolate, a compound mainly composed of salvia magnesium acetate, is extracted from the Chinese herb . Because of its biological activity, easy quality control and certain efficacy, salvianolate is widely used in treating ischemic cardiocerebral vascular disease, liver damage, renal injury, diabetes, and its complications. Particularly, it has potential protective effects on diabetic nephropathy (DN).
OBJECTIVE
This meta-analysis aimed to evaluate the efficacy and safety of salvianolate when combined with western medicine in patients affected with DN.
METHODS
We searched Pubmed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data knowledge service platform (Wanfang Data), Chinese Scientific Journal Database (VIP), and China Biology Medicine Disc (SinoMed) for randomized controlled trials (RCTs) of salvianolate in combination with western medicine on DN, including results from the foundation of each database until November 30, 2019. Two reviewers independently performed literature screening, data extraction, and quality evaluation. This meta-analysis was carried out using RevMan5.3 software.
RESULTS
From the 12 RCTs, 1,030 patients from China were involved. Compared with single-use western medicine, the combination of salvianolate and western medicine for the treatment of DN could reduce levels of serum creatinine (Scr) [MD=-16.53, 95% CI (-28.79, -4.27), =0.008], blood urea nitrogen (BUN) [MD=-1.40, 95% CI (-2.17, -0.62), =0.0004], urinary albumin excretion rate (UARE) [SMD=-1.84, 95% CI (-2.70, -0.98), < 0.0001], 24-hour urinary protein (24h Upro) [MD=-0.37, 95% CI (-0.47, -0.26), < 0.00001], albumin-to-creatinine ratio (ACR) [SMD=-1.43, 95% CI (-2.64, -0.23), =0.02], hypersensitive C-reactive protein (hs-CRP) [MD=-5.69, 95% CI (-7.09, -4.29), < 0.00001], interleukin-6 (IL-6) [MD=-12.53, 95% CI (-18.55, -6.52), < 0.0001], malondialdehyde (MDA) [SMD=-2.05, 95% CI (-3.67, -0.43), =0.01], as well as improve clinical efficacy [RR=1.21, 95% CI (1.12,1.31), < 0.00001], and increase superoxide dismutase (SOD) levels [SMD=1.12, 95% CI (0.86,1.38), < 0.00001]. No increase in the occurrence of serious adverse events were observed in the treatment group compared with the control group.
CONCLUSION
This study indicated that salvianolate combined with western medicine contributes to protecting renal function, inhibiting inflammation, and exhibiting anti-oxidative properties, thereby improving clinical efficacy. Thus, salvianolate can be considered as a potential complementary therapy for DN patients. However, due to the low quality of methodology and small sample sizes, more rigorous and larger trials are essential to validate our results.
PubMed: 32595500
DOI: 10.3389/fphar.2020.00851 -
Renal Failure Dec 2024To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by... (Meta-Analysis)
Meta-Analysis
Efficacy of astragalus combined with renin-angiotensin-aldosterone system blockers in the treatment of stage III diabetic nephropathy: a systematic review and meta-analysis.
OBJECTIVE
To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, Wiley, and Web of Science databases were searched for articles published between August 2007 and August 2022. Clinical studies on Astragalus combined with RAAS blockers for the treatment of stage III DN were included. Meta-analysis was performed by RevMan 5.1 and Stata 14.3 software.
RESULTS
A total of 32 papers were included in this meta-analysis, containing 2462 patients from randomized controlled trials, with 1244 receiving the combination treatment and 1218 solely receiving RAAS blockers. Astragalus combined with RAAS blockers yielded a significantly higher total effective rate (TER) (mean difference [MD] 3.63, 95% confidence interval [CI] 2.59-5.09) and significantly reduced urinary protein excretion rate (UPER), serum creatinine (Scr), blood urine nitrogen (BUN) and glycosylated hemoglobin (HbAlc) levels. In subgroup analysis, combining astragalus and angiotensin receptor blocker significantly lowered fasting plasma glucose (FPG) and 24 h urinary protein (24hUTP) levels, compared with the combined astragalus and angiotensin-converting enzyme inhibitor treatment. Meanwhile, the latter significantly decreased the urinary microprotein (β-MG). Importantly, the sensitivity analysis confirmed the study's stability, and publication bias was not detected for UPER, BUN, HbAlc, FPG, or β-MG. However, the TER, SCr, and 24hUTP results suggested possible publication bias.
CONCLUSIONS
The astragalus-RAAS blocker combination treatment is safe and improves outcomes; however, rigorous randomized, large-scale, multi-center, double-blind trials are needed to evaluate its efficacy and safety in stage III DN.
Topics: Humans; Diabetic Nephropathies; Angiotensin-Converting Enzyme Inhibitors; Renin-Angiotensin System; Drug Therapy, Combination; Angiotensin Receptor Antagonists; Astragalus Plant; Randomized Controlled Trials as Topic; Drugs, Chinese Herbal; Treatment Outcome; Creatinine; Glycated Hemoglobin; Proteinuria
PubMed: 38836372
DOI: 10.1080/0886022X.2024.2359033 -
Evidence-based Complementary and... 2022Wuling powder is a classical formula of traditional Chinese medicine (TCM), which is extensively applied to treat diabetic nephropathy (DN). However, there are no... (Review)
Review
BACKGROUND
Wuling powder is a classical formula of traditional Chinese medicine (TCM), which is extensively applied to treat diabetic nephropathy (DN). However, there are no related reports on systematically evaluating the efficacy of Wuling powder in the treatment of DN. Targeted at this, this study was developed.
MATERIALS AND METHODS
This study systematically searched related articles from nine databases, including PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Infrastructure (CNKI), China Biomedical CD-ROM (Sino Med), Wanfang database, Vipers database (VIP), and the China Clinical Trials Registry website. The randomized controlled trials (RCTs) involving Wuling Power to treat DN were included, which were published from the established data of the above databases to March 2022. In addition, the language of the studies was not restricted. Studies were meta-analyzed using the RevMan 5.4 software given in the Cochrane Collaboration Network. The treatment efficacy was measured using the weighted mean differences (WMD) and 95% confidence intervals (CI).
RESULTS
24 studies were included for the final analysis. 24 h urine volume (WMD = 357.95; 95% CI [322.83, 393.06], < 0.00001), 24 h urine protein quantification(24 h UPQ) (WMD = -1.30; 95% CI [-1.82, -0.78], < 0.00001), serum creatinine (Scr) (WMD = -10.17; 95% CI [-11.13, -9.21], < 0.00001), blood urea nitrogen (BUN) (WMD = -1.62; 95% CI [-2.30, -0.93], < 0.00001), urinary albumin excretion rate (UAER) (WMD = -24.73; 95% CI [-35.46, -13.99], < 0.00001), fasting blood glucose (FBG) (WMD = -0.63.95% CI [-0.97, -0.30], = 0.002), glycated hemoglobin (WMD = -0.11; 95% CI [-0.30, 0.08], =0.26), total cholesterol (TC) (WMD = -0.63; 95% CI [-1.23, -0.04], =0.04), triglycerides (TG) (WMD = -0.46. 95% CI [-0.70, -0.23], =0.0001), high-density lipoprotein cholesterol (HDL-C) (WMD = -0.32; 95% CI [0.03, 0.62], =0.03), low-density lipoprotein cholesterol (LDL-C) (WMD = -0.57; 95% CI [-0.77, -0.37], < 0.00001), and total effective rate (TER) (response ratio (RR) = 1.40; 95% CI [1.32, 1.48]; < 0.00001) were concluded. The Wuling powder in the treatment of DN was statistically significant in all the above outcome indicators, and the efficacy of the treatment group was better than that of the control group.
CONCLUSION
The results of this study provided evidence for the clinical application of Wuling powder to treat the DN, but it had to be further validated in higher-quality clinical studies.
PubMed: 36212947
DOI: 10.1155/2022/1720749 -
Heliyon Jan 2021This systematic review and meta-analysis was performed to evaluate the effect of probiotics on serum high sensitivity-C reactive protein (hs-CRP) and oxidative stress... (Review)
Review
This systematic review and meta-analysis was performed to evaluate the effect of probiotics on serum high sensitivity-C reactive protein (hs-CRP) and oxidative stress biomarkers among patients with Diabetic Nephropathy (DN). Electronic databases were searched through May 10, 2020. Seven trials that included 340 patients were identified for analysis. Meta-analysis indicated that probiotics significantly reduced hs-CRP (WMD = -1.53 mg/L; 95% CI = -2.38, -0.69; P < 0.001) and Malondialdehyde (MDA) (WMD = -0.62 ɥmol/L; 95% CI = -1.18, -0.06; P = 0.030) levels in DN patients, whereas they increased Glutathione (GSH) (WMD = 73.84 ɥmol/L; 95% CI = 24.3, 123.29; P = 0.003) and Total Antioxidant Capacity (TAC) (WMD = 26.54 mmol/L; 95% CI = 6.23, 46.85; P = 0.010). Therefore, probiotics may improve hs-CRP and oxidative stress biomarkers in DN population.
PubMed: 33490683
DOI: 10.1016/j.heliyon.2021.e05925