Prostaglandin E1 for preventing the progression of diabetic kidney disease.
Author(s): Wang H, Deng JL, Yue J, Li J, Hou YB.
Affiliation(s): Department of Geriatrics, West China Hospital, Sichuan University, 37 Guo Xue
Xiang, Chengdu, Sichuan, China, 610041.
Publication date & source: 2010, Cochrane Database Syst Rev. , (5):CD006872
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.
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