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Meta-Analysis
. 2014 Oct 22;2014(10):CD008369.
doi: 10.1002/14651858.CD008369.pub2.

Astragalus (a traditional Chinese medicine) for treating chronic kidney disease

Hong Wei Zhang  1 , Zhi Xiu Lin, Chuanshan Xu, Connie Leung, Lai Sum Chan
Affiliations
Meta-Analysis

Astragalus (a traditional Chinese medicine) for treating chronic kidney disease

Hong Wei Zhang et al. Cochrane Database Syst Rev. .

Abstract

Background: Astragalus (Radix Astragali, huang qi) is the dried root of Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao or Astragalus membranaceus (Fisch.) Bge. (Family Leguminosae). It is one of the most widely used herbs in traditional Chinese medicine for treating kidney diseases. Evidence is needed to help clinicians and patients make judgments about its use for managing chronic kidney disease (CKD).

Objectives: This review evaluated the benefits and potential harms of Astragalus for the treatment of people with CKD.

Search methods: We searched the Cochrane Renal Group's Specialised Register to 10 July 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We also searched CINAHL, AMED, Current Controlled Trials, OpenSIGLE, and Chinese databases including CBM, CMCC, TCMLARS, Chinese Dissertation Database, CMAC and Index to Chinese Periodical Literature.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs comparing Astragalus, used alone as a crude herb or an extract, with placebo, no treatment, or conventional interventions were eligible for inclusion.

Data collection and analysis: Two authors independently extracted data and assessed risk of bias in the included studies. Meta-analyses were performed using relative risk (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

Main results: We included 22 studies that involved 1323 participants, of whom 241 were receiving dialysis treatment. Risk of bias was assessed as high in six studies, and unclear in the remaining 16 studies. Study quality was low overall.Our nominated primary outcomes of time to requirement for renal replacement therapy (RRT) or initiation of dialysis and all-cause mortality were not reported in any of the included studies.Results concerning the effects of Astragalus on kidney function were inconsistent. Astragalus significantly increased CrCl at end of treatment (4 studies, 306 participants: MD 5.75 mL/min, 95% CI 3.16 to 8.34; I² = 0%), decreased SCr (13 studies, 775 participants: MD -21.39 µmol/L, 95% CI -34.78 to -8; I² = 70%) and especially in those whose baseline SCr was < 133 µmol/L in particular (3 studies, 187 participants: MD -2.52 µmol/l, 95% CI -8.47 to 3.42; I² = 0%). Astragalus significantly decreased 24 hour proteinuria at end of treatment (10 studies, 640 participants; MD -0.53 g/24 h, 95% CI -0.79 to -0.26; I² = 90%); significantly increased haemoglobin levels overall (4 studies, 222 participants): MD 9.51 g/L, 95% CI 4.90 to 14.11; I² = 0%) and in haemodialysis patients in particular (3 studies, 142 participants: MD 11.20 g/L, 95% CI 5.81 to 16.59; I² = 0%). Astragalus significantly increased serum albumin (9 studies, 522 participants: MD 3.55 g/L, 95% CI 2.33 to 4.78; I² = 65%). This significant increase was seen in both dialysis (3 studies, 152 participants): MD 4.04 g/L, 95% CI 1.91 to 6.16; I² = 72%) and non-dialysis patients (6 studies, 370 participants: MD 3.24 g/L, 95% CI 1.70 to 4.77; I² = 61%). Astragalus significantly decreased systolic blood pressure (2 studies, 77 participants: MD -16.65 mm Hg, 95% CI -28.83 to -4.47; I² = 50%), and diastolic blood pressure (2 studies, 77 participants: MD -6.02 mm Hg, 95% CI -10.59 to -1.46; I² = 0%).Six of 22 included studies reported no adverse effects were observed; while the remaining 16 studies did not report adverse effects.

Authors' conclusions: Although Astragalus as an adjunctive treatment to conventional therapies was found to offer some promising effects in reducing proteinuria and increasing haemoglobin and serum albumin, suboptimal methodological quality and poor reporting meant that definitive conclusions could not be made based on available evidence.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study selection flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot: Astragalus + conventional treatment versus conventional treatment alone, outcome: 1.4 SCr: end of treatment (μmol/L)
1.1
1.1. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 1 Creatinine clearance: end of treatment.
1.2
1.2. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 2 Glomerular filtration rate [ mL/min/1.73 m²].
1.3
1.3. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 3 Serum creatinine: end of treatment.
1.4
1.4. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 4 Creatinine clearance: end of follow‐up.
1.5
1.5. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 5 Serum creatinine: end of follow‐up.
1.6
1.6. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 6 Proteinuria: end of treatment.
1.7
1.7. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 7 Proteinuria: end of follow‐up.
1.8
1.8. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 8 Systolic blood pressure.
1.9
1.9. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 9 Diastolic blood pressure.
1.10
1.10. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 10 Haemoglobin.
1.11
1.11. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 11 Haematocrit.
1.12
1.12. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 12 Albumin.
1.13
1.13. Analysis
Comparison 1 Astragalus + conventional treatment versus conventional treatment alone, Outcome 13 Total cholesterol.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008369

References

References to studies included in this review

Bi 2007 {published data only}
    1. Bi ZJ. The exploration on the effect of Huang qi injection on decreasing urine protein on the elder patients with primary hypertension nephrology [Huang qi zhu she ye jiang di lao nian yuan f axing gao xue ya shen bing niao dan bai han liang de zuo yong tan tao]. Zhongxiyi Jiehe Xinnaoxueguanbing Zazhi [Chinese Journal of Integrative Medicine on Cardio‐Cerebrovascular Disease] 2007;5(12):1253.
Cheng 2001 {published data only}
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Li 2006 {published data only}
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Liu 2002 {published data only}
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Miao 2002 {published data only}
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Su 2007 {published data only}
    1. Su L, Mao JC, Gu JH. Effect of intravenous drip infusion of cyclophosphamide with high‐dose Astragalus injection in treating lupus nephritis [Huan lin xian an lian he da ji ilang huang qi zhu she ye jing mai di zhu zhi liao lang chuang xing shen yan]. Zhong Xiyi Jiehe Xuebao [Journal of Chinese Integrative Medicine] 2007;5(3):272‐5. [MEDLINE: ] - PubMed
Sun 1989 {published data only}
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Tao 2001 {published data only}
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Wang 2000 {published data only}
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Wu 2008 {published data only}
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Zhang 2006 {published data only}
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Zhu 2003 {published data only}
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References to studies excluded from this review

Chen 2004a {published data only}
    1. Chen LP, Zhou QL, Yang JH. Protective effects of astragali injection on tubular in patients with primary nephrotic syndrome [Huang qi zhu she ye dui shen bing zong he zheng huan zhe shen xiao guan de bao hu zuo yong]. Zhongnan Daxue Xuebao (Yixue Ban) [Journal of Central South University (Medical Sciences)] 2004;29(2):152‐3. [MEDLINE: ] - PubMed
Cui 2000 {published data only}
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Gao 2006 {published data only}
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Qiu 2008 {published data only}
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Qu 2008 {published data only}
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Qun 1999 {published data only}
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Wang 2004 {published data only}
    1. Wang HY, Chen YP. Clinical observation on treatment of diabetic nephropathy with compound fructus arctii mixture [Fu fang niu bang zi he ji zhi liao tang niao bing shen bing de lin chuang guan cha]. Zhongguo Zhongxiyi Jiehe Zazhi [Chinese Journal of Integrated Traditional and Western Medicine] 2004;24(7):589‐92. [MEDLINE: ] - PubMed
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Zhang 2005 {published data only}
    1. Zhang DY, Yang YL, Gao CQ, Yang LC, Xu HH. The efficacy of Astragalus injection on patients with primary chronic glomerular diseases [Huang qi zhu she ye dui yuan fa xing man xing shen xiao qiu ji bing de zhi liao zou yong]. Zhongguo Zhongxiyi Jiehe Shenbing Zazhi [Chinese Journal of Integrated Traditional and Western Nephrology] 2005;6(11):643‐5.
Zhu 2002 {published data only}
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Zuo 2003 {published data only}
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References to studies awaiting assessment

Biao 1992 {published data only}
    1. Biao S, Wang LH. Effect of astragalus membranaceus and captopril on proteinuria and renal function in chronic glomerulonephritis [abstract]. 9th Asian Colloquium in Nephrology; 1992 May 17‐21; Seoul, Korea. 1992:139. [CENTRAL: CN‐00460394]
Chen 1999 {published data only}
    1. Chen L. Observation on the treatment effect of Huang qi intravenous injection on chronic kidney failure [Huang qi jing mai zhu she ye zhi liao man xing shen shuai liao xiao guan cha]. The 5th national conference on the treatment of kidney disease by integrated Chinese and western medicine. 1999:253‐4.
Chen 2003 {published data only}
    1. Chen WX, Luo W, Ye CY. Clinical observation on the treatment of Huang qi injection on chronic kidney failure [Huang qi zhu she ye zhi liao man xing shen gong neng shuai jie lin chuang guan cha]. Linchuang Huicui [Clinical Focus] 2003;18(10):583‐4.
Cui 2005 {published data only}
    1. Cui B, Yao MY, Tao YF. The influence of Huang qi injection on the kidney function and endothelin [Huang qi zhu she ye dui man xing shen shuai jie bing ren shen gong neng ji nei pi su de ying xiang]. Zhongguo Zhongxiyi Jiehe Shenbing Zazhi [Chinese Journal of Integrated Traditional and Western Nephrology] 2005;6(3):166‐7.
Li 1999 {published data only}
    1. Li GQ, Liu YL. Clinical observation on the treatment of azotemia by Astragali combined by dopamine and ruijieting [Di ao huang qi yu duo ba an rui jie ting he yong zhi liao dan zhi xu zheng liao xiao guan cha]. Linchuang Huicui [Clinical Focus] 1999;14(S):273‐4.
Peng 1999 {published data only}
    1. Peng MQ. Observation on the treatment effect of Huang qi injection and intravascular low level He‐Ne laser irradiation for chronic kidney failure [Huang qi zhu she ye di neng liang hai nai ji guang xue guan nei zhao she shu er lian liao fa zhi liao man xing shen gong neng shuai jie lin chuang liao xiao guan cha]. The 5th national conference on the treatment of kidney disease by integrated Chinese and western medicine. 1999:226‐7.
Yu 2002 {published data only}
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References to other published versions of this review

Zhang 2010
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