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Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials.

ABSTRACT: Objective:This systematic review aims to investigate the efficacy and safety of moxibustion for chronic kidney disease (CKD). Methods:Nine databases were searched to identify relevant evidence up to March 8, 2020. Randomized controlled trials (RCTs) that tested moxibustion?+?basic treatments versus basic treatments alone for patients with CKD and reported, at least, one of the outcomes of interest were included. In the meta-analyses, the mean differences (MDs) and 95% confidence intervals (CIs) were used to measure the effect size. Results:Twenty-three RCTs (n?=?1571) with a moderate to high risk of bias were included. The pooled estimates showed that compared with the controls, patients after moxibustion had a significant reduction in serum creatinine (MD -17.34??mol/L, 95% CI -28.44 to -6.23; I 2?=?87%), 24-hour urine protein excretion (MD -0.75?g/h, 95% CI -1.07 to -0.42; I 2?=?84%), and blood urea nitrogen (MD -0.63?mmol/L, 95% CI -1.09 to -0.18; I 2?=?37%) and a significant improvement in the quality of life (MD 10.18, 95% CI 3.67 to 16.69; I 2?=?57%). Moxibustion did not show a significant effect on the estimated glomerular filtration rate (eGFR), creatinine clearance, or hemoglobin. The subgroup analyses showed that a longer course of moxibustion (>8 weeks) and indirect moxibustion had a greater effect on reducing serum creatinine. The effect of moxibustion on blood urea nitrogen changed to be nonsignificant after excluding RCTs with a high risk of bias (MD -0.96?mmol/L, 95% CI -2.96 to 1.03). Only one adverse event of burn was reported. Conclusions:This systematic review suggests that, as an adjuvant therapy, moxibustion may improve serum creatinine, urinary protein excretion, blood urea nitrogen, and quality of life in patients with CKD. Moxibustion may not have effects on eGFR, creatinine clearance, or hemoglobin. The quality of evidence is weakened by the limitations of risk of bias, heterogeneity, and imprecision.

SUBMITTER: Zhou X

PROVIDER: S-EPMC7641698 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials.

Zhou Xu X Wu Qingni Q Wang Yanping Y Ren Qing Q Zhu Weifeng W Yao Ziqian Z Chen Jianrong J

Evidence-based complementary and alternative medicine : eCAM 20201028

<h4>Objective</h4>This systematic review aims to investigate the efficacy and safety of moxibustion for chronic kidney disease (CKD).<h4>Methods</h4>Nine databases were searched to identify relevant evidence up to March 8, 2020. Randomized controlled trials (RCTs) that tested moxibustion + basic treatments versus basic treatments alone for patients with CKD and reported, at least, one of the outcomes of interest were included. In the meta-analyses, the mean differences (MDs) and 95% confidence i ...[more]

PMID: 33193796

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Project description:BackgroundYiqi Fumai injection (YQFM) is a traditional Chinese medicine widely used for cardiovascular diseases in China. This systematic review aimed to evaluate whether YQFM could be an effective and safe complementary therapy for chronic heart failure (CHF).MethodsEight electronic literature databases were searched up to March 31, 2020. Randomized controlled trials (RCTs) comparing YQFM + conventional treatment with conventional treatment alone for CHF were included. The primary outcome was response to treatment, which was graded by improvements in heart function based on the New York Heart Association (NYHA) criteria, while the secondary outcomes included the left ventricular ejection fraction (LVEF), cardiac output, left ventricular end-systolic diameter (LVESD), amino-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk test performance (6MWT), quality of life (QoL) as assessed by the Minnesota Living with Heart Failure questionnaire, and adverse reactions. Data from individual RCTs were pooled by a random-effects meta-analysis with effect measures of proportional odds ratios (pORs) and 95% confidence intervals (95% CIs) for the ordinal outcomes and the mean difference (MD) and 95% CI for the continuous outcomes.ResultsIn total, 33 RCTs involving 3070 patients with an overall moderate-to-high risk of bias were selected. The meta-analysis showed that compared with conventional treatment alone, YQFM plus conventional treatment had a significantly higher likelihood of improving the response to treatment (pOR 1.88, 95% CI 1.47 to 2.42, I 2 = 0%). YQFM also significantly improved the LVEF (MD 5.53%, 95% CI 4.73 to 6.33, I 2 = 82%), cardiac output (MD 0.32 L/min, 95% CI 0.19 to 0.45, I 2 = 47%), and LVESD (MD -3.73 mm, 95% CI -5.51 to -1.95, I 2 = 22%), reduced the NT-proBNP levels (MD -341.83 pg/mL, 95% CI -417.89 to -265.77, I 2 = 88%), and improved the 6MWT (MD 61.86 m, 95% CI 45.05 to 78.67, I 2 = 64%) and QoL (MD -9.82, 95% CI -14.17 to -5.46, I 2 = 81%). No serious adverse events related to YQFM were reported.ConclusionAlthough limited by a moderate-to-high risk of bias, the current evidence suggests that YQFM as a complementary treatment significantly improves heart function and related indicators in patients with CHF. The clinical use of YQFM needs careful safety monitoring. Well-designed studies are still required to further evaluate the efficacy and safety of YQFM for CHF.

Project description:ObjectiveGut flora imbalance characterizes patients with chronic kidney disease (CKD). Although biotic supplementation has been proposed to lessen inflammation and oxidative stress and, thus, reduce the risk of progressive kidney damage and cardiovascular disease, the effects remain controversial. We conducted a meta-analysis to assess the therapeutic benefits of biotics in CKD.MethodsPubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials that evaluated any biotic (prebiotic, probiotic, synbiotics) supplements in patients with CKD (CKD, stage 3-4 to end-stage renal disease). Primary endpoints included changes in renal function, markers of inflammation, and oxidative stress. Secondary endpoints included changes in levels of uremic toxins and variations in lipid metabolism.ResultsTwenty-three eligible studies included 842 participants. In a pooled-analysis, biotics did not change estimated glomerular filtration rate (mean difference [MD] = 0.08, P = .92) or serum albumin (MD = -0.01, P = .86), although prebiotics reduced serum creatinine (standardized mean difference [SMD] = -0.23, P = .009) and blood urea nitrogen (MD = -6.05, P < .00001). Biotics improved total antioxidative capacity (SMD = 0.37, P = .007) and malondialdehyde (SMD = -0.96, P = .006) and reduced the inflammatory marker interleukin-6 (SMD = -0.30, P = .01) although not C-reactive protein (SMD = -0.22, P = .20). Biotic intervention reduced some uremic toxins, including p-cresol sulfate (SMD = -2.18, P < .0001) and indoxyl sulfate (MD = -5.14, P = .0009), which decreased in dialysis-dependent patients. Another toxin, indole-3-acetic acid (MD = -0.22, P = .63), did not change. Lipids were unaffected by biotic intervention (total cholesterol: SMD = -0.01, P = .89; high-density lipoprotein: SMD = -0.08, P = .76; low-density lipoprotein: MD = 3.54, P = .28; triglyceride: MD = -2.26, P = .58).ConclusionThe results highlight the favorable influence of biotics on circulating markers of creatinine, oxidant stress (malondialdehyde, total antioxidative capacity), inflammation (interleukin-6), and uremic toxins (p-cresol sulfate) in patients with CKD. Biotics did not affect estimated glomerular filtration rate, albumin, indole-3-acetic acid, or lipids in either predialysis or dialysis patients.

Project description:Background Primary osteoporosis (PO) is a systemic metabolic skeletal disease. Previous studies have shown that moxibustion can reduce pain intensity and enhance response rate, bone mineral density (BMD), and living function of the patients with PO. However, consensus on its efficacy does not exist, and evidence of moxibustion for PO is also insufficient. Methods We searched five English and four Chinese databases with various additional sources and published reviews through December 1, 2021, to evaluate potentially concerned randomized controlled trials (RCTs). Two independent researchers addressed selection screening, data extraction, and risk of bias assessment. The data of this meta-analysis were analyzed using the RevMan v.5.4 software. Additionally, the trial sequential analysis v.0.9.5.10 β was used to estimate the sample size. In contrast, the quality of evidence from the RCTs was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Results The current meta-analysis included 14 RCTs containing 898 participants. The methodological quality of the RCTs was moderate. The review demonstrated that a combination of moxibustion and conventional medicine (CM) significantly reduced pain intensity and improved the BMD compared with CM. Furthermore, it was found that moxibustion plus CM/moxibustion could improve response rates compared with CM. However, it was found that the reduction of pain intensity and improvement of BMD by moxibustion showed no significant difference compared with CM. It was also evident that the sample size of most outcomes was inadequate. Moreover, all evidence obtained in this study was ranked as low to critically low. Conclusions In conclusion, it was demonstrated that moxibustion is a potentially effective agent for treating PO. However, high-quality studies should be implemented in the future because this study only obtained low-quality evidence. This study was registered in the PROSPERO platform (CRD42021291310).

Project description:BackgroundCalcimimetic agents lower serum parathyroid hormone levels in people with chronic kidney disease (CKD), but treatment effects on patient-relevant outcomes are uncertain. We conducted a systematic review and meta-analysis to summarize the benefits and harms of calcimimetic therapy in adults with CKD and used cumulative meta-analysis to identify how evidence for calcimimetic treatment has developed in this clinical setting.Methods and findingsCochrane and Embase databases (through February 7, 2013) were electronically searched to identify randomized trials evaluating effects of calcimimetic therapy on mortality and adverse events in adults with CKD. Two independent reviewers identified trials, extracted data, and assessed risk of bias. Eighteen trials comprising 7,446 participants compared cinacalcet plus conventional therapy with placebo or no treatment plus conventional therapy in adults with CKD. In moderate- to high-quality evidence (based on Grading of Recommendations Assessment, Development, and Evaluation criteria) in adults with CKD stage 5D (dialysis), cinacalcet had little or no effect on all-cause mortality (relative risk, 0.97 [95% confidence interval, 0.89-1.05]), had imprecise effect on cardiovascular mortality (0.67 [0.16-2.87]), and prevented parathyroidectomy (0.49 [0.40-0.59]) and hypercalcemia (0.23 [0.05-0.97]), but increased hypocalcemia (6.98 [5.10-9.53]), nausea (2.02 [1.45-2.81]), and vomiting (1.97 [1.73-2.24]). Data for clinical outcomes were sparse in adults with CKD stages 3-5. On average, treating 1,000 people with CKD stage 5D for 1 y had no effect on survival and prevented about three patients from experiencing parathyroidectomy, whilst 60 experienced hypocalcemia and 150 experienced nausea. Analyses were limited by insufficient data in CKD stages 3-5 and kidney transplant recipients.ConclusionsCinacalcet reduces the need for parathyroidectomy in patients with CKD stage 5D, but does not appear to improve all-cause or cardiovascular mortality. Additional trials in CKD stage 5D are unlikely to change our confidence in the treatment effects of cinacalcet in this population.

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Dataset Information

Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials.

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Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials.

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