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Prostaglandin E1 for preventing the progression of diabetic kidney disease.
Cochrane Database Syst Rev. 2010 May 12CD

Abstract

BACKGROUND

Diabetic kidney disease (DKD) is one of the major chronic microvascular complications in diabetes mellitus, and may progress to end-stage kidney disease (ESKD). There are no definitely effective approaches for preventing, delaying or treating DKD. Small studies have shown that Prostaglandin E1 (PGE1) can improve renal blood circulation and decrease proteinuria and albuminuria.

OBJECTIVES

To assess the benefits and harms of PGE1 for preventing the progression of DKD.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedicine Database (CBM) and reference lists of articles with no language restriction.

SELECTION CRITERIA

All randomised controlled trials (RCTs) or quasi-RCTs comparing any PGE1 agent used for preventing the progression of DKD, regardless of dosage, mode of administration, addition of cointerventions or duration of treatment.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. For dichotomous outcomes (all-cause mortality, ESKD), results were expressed as relative risk (RR) with 95% confidence intervals (CI). Continuous outcomes (microalbuminuria, proteinuria, albuminuria, doubling of serum creatinine, serum creatinine) were expressed as mean difference (MD) with 95% CI.

MAIN RESULTS

Six studies (271 patients) were included. Five studies investigated PGE1 with or without fosinopril/losartan versus fosinopril/losartan or no treatment and one compared PGE1 versus Xueshuantong (a Chinese medicinal herb). There was a significant decrease in urinary albumin excretion rate (UAER) in patients treated with PGE1 (MD -48.28 microg/min, 95% CI -75.29 to -21.28), other outcomes also showed a significant decrease in the patients with PGE1 (albuminuria: MD -143.66 mg/24 h, 95% CI -221.48 to -65.84; proteinuria: MD -300 g/24 h, 95% CI -518.34 to -81.66). PGE1 had a positive effect on albuminuria (MD -660 mg/24 h, 95% CI -867.07 to -452.93) in clinical DKD (CDN, III stage of DN) compared with Xueshuantong. No data on incidence of ESKD, all-cause mortality or quality of life were available.

AUTHORS' CONCLUSIONS

PGE1 may have positive effects on DKD by reducing UAER, decreasing albuminuria and lessening proteinuria, with no obvious serious adverse events. However, limited by the poor methodological quality of the included studies and the small number of participants, there is currently insufficient evidence for determining if PGE1 could be used for preventing the progression of DKD. Large, properly randomised, placebo-controlled, double-blind studies are urgently needed.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Wang H
Department of Geriatrics, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
Deng JL
No affiliation info available
Yue J
No affiliation info available
Li J
No affiliation info available
Hou YB
No affiliation info available

MeSH

AlbuminuriaAlprostadilDiabetic NephropathiesDisease ProgressionDrugs, Chinese HerbalFosinoprilHumansLosartanProteinuriaRandomized Controlled Trials as TopicVasodilator Agents

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

20464745

Citation

Wang, Han, et al. "Prostaglandin E1 for Preventing the Progression of Diabetic Kidney Disease." The Cochrane Database of Systematic Reviews, 2010, p. CD006872.
Wang H, Deng JL, Yue J, et al. Prostaglandin E1 for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev. 2010.
Wang, H., Deng, J. L., Yue, J., Li, J., & Hou, Y. B. (2010). Prostaglandin E1 for preventing the progression of diabetic kidney disease. The Cochrane Database of Systematic Reviews, (5), CD006872. https://doi.org/10.1002/14651858.CD006872.pub2
Wang H, et al. Prostaglandin E1 for Preventing the Progression of Diabetic Kidney Disease. Cochrane Database Syst Rev. 2010 May 12;(5)CD006872. PubMed PMID: 20464745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prostaglandin E1 for preventing the progression of diabetic kidney disease. AU - Wang,Han, AU - Deng,Jue Lin, AU - Yue,Jirong, AU - Li,Jun, AU - Hou,Yan Bin, Y1 - 2010/05/12/ PY - 2010/5/14/entrez PY - 2010/5/14/pubmed PY - 2010/6/17/medline SP - CD006872 EP - CD006872 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 5 N2 - BACKGROUND: Diabetic kidney disease (DKD) is one of the major chronic microvascular complications in diabetes mellitus, and may progress to end-stage kidney disease (ESKD). There are no definitely effective approaches for preventing, delaying or treating DKD. Small studies have shown that Prostaglandin E1 (PGE1) can improve renal blood circulation and decrease proteinuria and albuminuria. OBJECTIVES: To assess the benefits and harms of PGE1 for preventing the progression of DKD. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedicine Database (CBM) and reference lists of articles with no language restriction. SELECTION CRITERIA: All randomised controlled trials (RCTs) or quasi-RCTs comparing any PGE1 agent used for preventing the progression of DKD, regardless of dosage, mode of administration, addition of cointerventions or duration of treatment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. For dichotomous outcomes (all-cause mortality, ESKD), results were expressed as relative risk (RR) with 95% confidence intervals (CI). Continuous outcomes (microalbuminuria, proteinuria, albuminuria, doubling of serum creatinine, serum creatinine) were expressed as mean difference (MD) with 95% CI. MAIN RESULTS: Six studies (271 patients) were included. Five studies investigated PGE1 with or without fosinopril/losartan versus fosinopril/losartan or no treatment and one compared PGE1 versus Xueshuantong (a Chinese medicinal herb). There was a significant decrease in urinary albumin excretion rate (UAER) in patients treated with PGE1 (MD -48.28 microg/min, 95% CI -75.29 to -21.28), other outcomes also showed a significant decrease in the patients with PGE1 (albuminuria: MD -143.66 mg/24 h, 95% CI -221.48 to -65.84; proteinuria: MD -300 g/24 h, 95% CI -518.34 to -81.66). PGE1 had a positive effect on albuminuria (MD -660 mg/24 h, 95% CI -867.07 to -452.93) in clinical DKD (CDN, III stage of DN) compared with Xueshuantong. No data on incidence of ESKD, all-cause mortality or quality of life were available. AUTHORS' CONCLUSIONS: PGE1 may have positive effects on DKD by reducing UAER, decreasing albuminuria and lessening proteinuria, with no obvious serious adverse events. However, limited by the poor methodological quality of the included studies and the small number of participants, there is currently insufficient evidence for determining if PGE1 could be used for preventing the progression of DKD. Large, properly randomised, placebo-controlled, double-blind studies are urgently needed. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/20464745/Prostaglandin_E1_for_preventing_the_progression_of_diabetic_kidney_disease_ L2 - https://doi.org/10.1002/14651858.CD006872.pub2 DB - PRIME DP - Unbound Medicine ER -