Clinical Efficacy of Jinshuibao Capsules Combined with Angiotensin Receptor Blockers in Patients with Early Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background

Jinshuibao capsules (JSB) have been widely used to treat early diabetic nephropathy (DN), but the specific effects are still inconsistent. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the clinical efficacy of JSB for early DN.

Methods

Four international databases and four Chinese databases were searched from publication dates to March 1, 2018. The RCTs reporting the results of JSB's specific effects were included, and comparisons were between JSB combined with Angiotensin Receptor Blockers (ARBs) as experimental intervention and ARBs as the control. Included studies' quality was evaluated and the extracted data were analyzed with RevMan 5.3 software.

Results

Twenty-six RCTs including 2198 early DN participants were adopted in the meta-analysis. The results showed that, compared with the ARBs alone, JSB could remarkably improve the ORR (OR = 3.84; 95% CI: 2.37~6.24; P < 0.00001) and decrease 24 h UTP (MD = −93.32; 95% CI: −128.60 ~−58.04; P < 0.00001), UAER (MD = −24.02; 95% CI: −30.93 ~−17.11; P < 0.00001), BUN (MD = −0.26; 95%: −0.44 ~−0.08; P = 0.005), Scr (MD = −9.07; 95% CI: −14.26 ~−3.88; P = 0.0006), ACR (MD = −17.55; 95% CI: −22.81 ~−12.29; P < 0.00001), Cys-C (MD = −0.60; 95% CI: −0.88 ~−0.32; P < 0.00001), SBP (MD = −3.08; 95% CI: −4.65 ~−1.52; P = 0.0001), DBP (MD = −2.09; 95% CI: −4.00 ~−0.19; P = 0.03), and TG (MD = −0.36; 95% CI: −0.50 ~−0.21; P < 0.00001). However, it showed no significant differences in TC (MD = −0.32; 95% CI: −0.69~0.04; P = 0.08), FBG (MD = 0.04; 95% CI: −0.39~0.47; P = 0.87), HbA _1c (MD = −0.26; 95% CI: −0.59~0.06; P = 0.11), and β ₂-MG (MD = −15.61; 95% CI: −32.95~1.73; P = 0.08).

Conclusions

This study indicates that JSB is an effective accessory therapeutic medicine for patients with early DN. It contributes to decreasing blood pressure and the content of triglyceride and improving the renal function of early DN patients. However, there is still a need to further verify the auxiliary therapeutic effect of JSB with more strictly designed RCTs with large sample and multiple centers in the future.