Pentoxifylline for diabetic kidney disease
Kidney disease develops in 25% to 40% of diabetic patients, usually 20 to 25 years after the onset of diabetes. Approximately one third of those with diabetic kidney disease (DKD) will progress to end-stage kidney disease (ESKD) and will require long-term dialysis or possibly receive a kidney transplant. Many patients however may die from associated coronary artery disease or other cardiovascular causes before the onset of ESKD. Pentoxifylline has been described as offering properties that may be beneficial for patients with DKD. We reviewed 17 randomised controlled studies, enrolling 991 patients with DKD, which compared pentoxifylline with placebo, routine treatment or antihypertensive drugs.

Compared with placebo, pentoxifylline significantly reduced serum creatinine (SCr), albuminuria, and overt proteinuria, but not creatinine clearance (CrCl). When compared with routine treatment alone, pentoxifylline did not reduce SCr or blood pressure, but did significantly reduce albuminuria and proteinuria. Compared to captopril or clonidine/methyldopa there was no significant difference in SCr, albuminuria, proteinuria or blood pressure for patients with type 1 and type 2 DKD. CrCl was significantly increased when pentoxifylline was compared to clonidine/methyldopa but not with captopril. No data were available on the incidence of ESKD, time to ESKD, quality of life, or all-cause mortality. The adverse events of pentoxifylline were mild; no serious adverse events were reported in any of the included studies.

Pentoxifylline seemed to have some beneficial effects in improving kidney function and reducing albuminuria and proteinuria (which can indicate kidney health) for patients with DKD, and was not associated with any major adverse effects. However, the current evidence on the effects of pentoxifylline for patients with DKD was insufficient to formulate therapeutic recommendations. More large, high-quality randomised studies are needed to better inform clinical decision making about the use pentoxifylline for patients with DKD.