Effectiveness of Acupuncture for Diabetic Nephropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
-
Cui Wu
,
Yuandong Li
,
Chunli Piao
,
Jiuru Wu
Abstract
Background: This systematic review and meta-analysis aimed to explore the effectiveness of acupuncture for patients with diabetic nephropathy (DN).
Methods: Nine online databases were searched: China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data Knowledge Service Platform, Chinese BioMedical Literature Database, China Clinical Trial Centre, Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the establishment of the database to 1 September 2023. The quality of the literature was evaluated using the Cochrane Risk of Bias Assessment Tool, and the data were analyzed using STATA/MP17 and Review Manager 5.3 software.
Results: A total of 221 articles were identified, and 13 studies were included. The total sample size was 899, including 452 and 447 cases in the experimental and control groups, respectively. The meta-analysis showed that acupuncture combined with modern medical treatment was effective in improving urinary albumin excretion rate, 24 h urinary microalbumin, serum creatinine, blood urea nitrogen, fasting plasma glucose, 2 h postprandial plasma glucose, total cholesterol, high-density lipoprotein cholesterol, hypersensitive C-reactive protein, and interleukin-6 in patients with DN. Adverse events were reported in only one trial; therefore, this review cannot yet conclude on the safety of acupuncture intervention in DN.
Conclusion: The clinical efficacy of acupuncture combined with modern medicine in DN is superior to that of modern medicine alone. To better evaluate the efficacy and safety of acupuncture intervention for DN, more rigorously designed large-sample, multicentre, randomized controlled trials are needed to provide evidence support in the future.
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12. Jiang SM, Fang JY (2020). Expert consensus on multidisciplinary diagnosis, treat-ment and management of diabetes nephropathy. Chin J Clin, 18:484–7.
13. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration's tool for assessing risk of bias in ran-domised trials. BMJ, 343:d5928.
14. Zhang Y, Sun Y, Hu X, et al (2024). The val-ue of cholinesterase inhibitors for im-proving neuropsychiatric and functional assessment scores in patients with Alz-heimer disease: a systematic review and meta-analysis of on placebo-controlled RCTs. Int J Surg, 110(6):3937-3945.
15. Zheng W, Pan Y, Li K, et al (2024). The correlation between rapid eye move-ment sleep behavior disorder and the progress of Parkinson's disease: a sys-tematic review and meta-analysis. Front Aging Neurosci, 16:1418751.
16. Guyatt GH, Oxman AD, Vist GE, et al (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650):924-6.
17. Chen GC, Chen WD (2006).30 Cases of di-abetes Nephropathy Treated with West-ern Medicine and Acupuncture. Guang-ming Journal of Chinese Medicine, 01:36-38.
18. Chen YB, Chen RN, Li YL (2012). Observa-tion on therapeutic effect of type Il ear-ly diabetic nephropathies intervened by acupoint thread embedding. Zhongguo Zhen Jiu, 32(5):390-4.
19. Chu Q, Wang L, Liu GZ (2007). Clinical ob-servation on acupuncture for treatment of diabetic nephropathy. Zhongguo Zhen Jiu, 27(7):488-90.
20. Fan C (2011). Acupuncture treatment of di-abetic and kidney disease, Probe into acupuncture points in ancient and its modern clinical research. Guangzhou University of Chinese Medicine.
21. Fei AH (2012). Therapeutic Evaluation of Moxibustion of Tonifying Kidney and Activating Blood Circulation in Treating Early-stage Diabetic Nephropathy and lts Effect on NO. Shanghai J Acup and Moxib, 31(12):891–892.
22. Guo XY (2016). Observation on therapeutic effect of auricular point application on 42 cases of diabetes nephropathy. Yun-nan Tradit ChinMed, 31(10):49.
23. Hu KL (2021). Clinical observation of mild moxibustion at Beishu point in the treatment of early type 2 diabetic kidney disease and its effect on inflammatory factors. Anhui University of Chinese Medi-cine.
24. Ji XQ, Yu SH, Xue L, et al (2004). Effect of acupuncture combined with low protein diet on diabetic early Nephropathies. Chin Acup Moxib, 9:7-9.
25. Tang M, Xu JS (2022). Effect Analysis of Warm Acupuncture and Moxibustion in the Treatment of Diabetic Nephropathy with Spleen and Kidney Yang Deficien-cy. Diabetes New World, 25(05):165-175.
26. Wang XJ (2014). Clinical research of auric-ular acupressure treatment of early dia-betic nephropathy in type 2 diabetes. Shanxi University of Traditional Chinese med-icine.
27. Yang XY (2013). Clinical Analysis of 27 Cases of diabetes Nephropathy Treated by Acupuncture with the Method of Supplementing Qi and Activating Blood Circulation. Xinjiang Journal of Traditional Chinese Medicine, 31(05):45-47.
28. Yuan L, Gao C, Xing XL, et al (2020). Ef-fect of auricular point pressing pill method combined with heat sensitive moxibustion on inflammatory level and immune function of early diabetic nephropathy patients. Nursing Research, 34(16):2833-2836.
29. Zhang CZ, Zhang JH, Zhang RJ, et al (2006). The effect of meridian acupunc-ture point burial therapy on beta_2-MG, uIgG and others in early diabetic nephropathy. Journal of Practical Diabetolo-gy, 03:36-38.
30. Chen B, Benedetti A (2017). Quantifying heterogeneity in individual participant data meta-analysis with binary out-comes. Syst Rev, 6(1):243.
31. Inoue K (2019). Sensitivity analysis for re-producible candidate values of model parameters in signaling hub model. PLoS One, 14(2):e0211654.
32. Kaptchuk TJ (2002). Acupuncture: theory, efficacy, and practice. Ann Intern Med, 136(5):374-83.
33. Kim G, Kim D, Moon H, et al (2023). Acu-puncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis. Am J Chin Med, 51(2):223-247.
34. Zhang J, Zhang Z, Huang S, et al (2022). Acupuncture for cancer-related insom-nia: A systematic review and meta-analysis. Phytomedicine, 102:154160.
35. Zhu J, Li J, Yang L, et al (2021). Acupunc-ture, from the ancient to the current. Anat Rec (Hoboken), 304(11):2365-2371.
36. Feng Y, Fang Y, Wang Y, et al (2018). Acu-point Therapy on Diabetes Mellitus and Its Common Chronic Complications: A Review of Its Mechanisms. Biomed Res Int, 2018:3128378.
37. Yang J, Liu Z (2022). Mechanistic Patho-genesis of Endothelial Dysfunction in Diabetic Nephropathy and Retinopathy. Front Endocrinol (Lausanne), 13:816400.
38. Tang G, Li S, Zhang C, et al (2021). Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management. Acta Pharm Sin B, 11(9):2749-2767.
39. Shin HR, Park K, Seo J, et al (2019). Acu-puncture for perioperative care of total hip arthroplasty: A systemic review of controlled trials and meta-analysis. Medi-cine (Baltimore), 98(15):e15198.
40. Zhang J, Yang X, Zhang X, et al (2021). Electro-Acupuncture Protects Diabetic Nephropathy-Induced Inflammation Through Suppression of NLRP3 In-flammasome in Renal Macrophage Iso-lation. Endocr Metab Immune Disord Drug Targets, 21(11):2075-2083.
41. Yue JI, Xin-Yuan ZHANG, Yun-Ming XIAO, et al (2024). Acupuncture improve proteinuria in diabetic kidney disease rats by inhibiting ferroptosis and epithe-lial-mesenchymal transition. Heliyon, 10(13):e33675.
42. Jia N, Li R, B Y, et al (2017). Effects of electroacupuncture at “Zusanli” and “Shenshu” on GLUT2 and GCK in T2DM rats. World Chinese Med, 12(5):1114–1119.
2. Patterson CC, Karuranga S, Salpea P, et al (2019). Worldwide estimates of inci-dence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract, 157:107842.
3. Chinese Elderly Type 2 Diabetes Preven-tion and Treatment of Clinical Guide-lines Writing Group (2022). Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition). Zhonghua Nei Ke Za Zhi, 61(1):12-50.
4. Wang M, Liu W, Ge J, et al (2023). The im-munomodulatory mechanisms for acu-puncture practice. Front Immunol, 14:1147718.
5. Mallory MJ, Do A, Bublitz SE, et al (2016). Puncturing the myths of acupuncture. J Integr Med, 14(5):311-4.
6. Tang Y, Yang J, Wang J, et al (2024). Effects of Acupuncture Combined with Yi Qi Yang Yin and Blood Activating Formula on Blood Glucose and Renal Function in Early Diabetic Nephropathy: A Ran-domized Controlled Trial. Altern Ther Health Med, AT8923.
7. Yu JS, Ho CH, Wang HY, et al (2017). Acu-puncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Con-trolled Study. J Altern Complement Med, 23(8):624-631.
8. Xiong W, He FF, You RY, et al (2018). Acu-puncture Application in Chronic Kidney Disease and its Potential Mechanisms. Am J Chin Med, 46(6):1169-1185.
9. Wang F, Dai EL (2020). Progress in the Treatment of Diabetic Nephropathy with Acupuncture and Drug. Chin J Eth-nomed Ethnopharm, 29(07):38-40.
10. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting system-atic reviews. BMJ, 372:n71.
11. Nagendrababu V, Dilokthornsakul P, Jina-tongthai P, et al (2020). Glossary for sys-tematic reviews and meta-analyses. Int Endod J, 53(2):232-249.
12. Jiang SM, Fang JY (2020). Expert consensus on multidisciplinary diagnosis, treat-ment and management of diabetes nephropathy. Chin J Clin, 18:484–7.
13. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration's tool for assessing risk of bias in ran-domised trials. BMJ, 343:d5928.
14. Zhang Y, Sun Y, Hu X, et al (2024). The val-ue of cholinesterase inhibitors for im-proving neuropsychiatric and functional assessment scores in patients with Alz-heimer disease: a systematic review and meta-analysis of on placebo-controlled RCTs. Int J Surg, 110(6):3937-3945.
15. Zheng W, Pan Y, Li K, et al (2024). The correlation between rapid eye move-ment sleep behavior disorder and the progress of Parkinson's disease: a sys-tematic review and meta-analysis. Front Aging Neurosci, 16:1418751.
16. Guyatt GH, Oxman AD, Vist GE, et al (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650):924-6.
17. Chen GC, Chen WD (2006).30 Cases of di-abetes Nephropathy Treated with West-ern Medicine and Acupuncture. Guang-ming Journal of Chinese Medicine, 01:36-38.
18. Chen YB, Chen RN, Li YL (2012). Observa-tion on therapeutic effect of type Il ear-ly diabetic nephropathies intervened by acupoint thread embedding. Zhongguo Zhen Jiu, 32(5):390-4.
19. Chu Q, Wang L, Liu GZ (2007). Clinical ob-servation on acupuncture for treatment of diabetic nephropathy. Zhongguo Zhen Jiu, 27(7):488-90.
20. Fan C (2011). Acupuncture treatment of di-abetic and kidney disease, Probe into acupuncture points in ancient and its modern clinical research. Guangzhou University of Chinese Medicine.
21. Fei AH (2012). Therapeutic Evaluation of Moxibustion of Tonifying Kidney and Activating Blood Circulation in Treating Early-stage Diabetic Nephropathy and lts Effect on NO. Shanghai J Acup and Moxib, 31(12):891–892.
22. Guo XY (2016). Observation on therapeutic effect of auricular point application on 42 cases of diabetes nephropathy. Yun-nan Tradit ChinMed, 31(10):49.
23. Hu KL (2021). Clinical observation of mild moxibustion at Beishu point in the treatment of early type 2 diabetic kidney disease and its effect on inflammatory factors. Anhui University of Chinese Medi-cine.
24. Ji XQ, Yu SH, Xue L, et al (2004). Effect of acupuncture combined with low protein diet on diabetic early Nephropathies. Chin Acup Moxib, 9:7-9.
25. Tang M, Xu JS (2022). Effect Analysis of Warm Acupuncture and Moxibustion in the Treatment of Diabetic Nephropathy with Spleen and Kidney Yang Deficien-cy. Diabetes New World, 25(05):165-175.
26. Wang XJ (2014). Clinical research of auric-ular acupressure treatment of early dia-betic nephropathy in type 2 diabetes. Shanxi University of Traditional Chinese med-icine.
27. Yang XY (2013). Clinical Analysis of 27 Cases of diabetes Nephropathy Treated by Acupuncture with the Method of Supplementing Qi and Activating Blood Circulation. Xinjiang Journal of Traditional Chinese Medicine, 31(05):45-47.
28. Yuan L, Gao C, Xing XL, et al (2020). Ef-fect of auricular point pressing pill method combined with heat sensitive moxibustion on inflammatory level and immune function of early diabetic nephropathy patients. Nursing Research, 34(16):2833-2836.
29. Zhang CZ, Zhang JH, Zhang RJ, et al (2006). The effect of meridian acupunc-ture point burial therapy on beta_2-MG, uIgG and others in early diabetic nephropathy. Journal of Practical Diabetolo-gy, 03:36-38.
30. Chen B, Benedetti A (2017). Quantifying heterogeneity in individual participant data meta-analysis with binary out-comes. Syst Rev, 6(1):243.
31. Inoue K (2019). Sensitivity analysis for re-producible candidate values of model parameters in signaling hub model. PLoS One, 14(2):e0211654.
32. Kaptchuk TJ (2002). Acupuncture: theory, efficacy, and practice. Ann Intern Med, 136(5):374-83.
33. Kim G, Kim D, Moon H, et al (2023). Acu-puncture and Acupoints for Low Back Pain: Systematic Review and Meta-Analysis. Am J Chin Med, 51(2):223-247.
34. Zhang J, Zhang Z, Huang S, et al (2022). Acupuncture for cancer-related insom-nia: A systematic review and meta-analysis. Phytomedicine, 102:154160.
35. Zhu J, Li J, Yang L, et al (2021). Acupunc-ture, from the ancient to the current. Anat Rec (Hoboken), 304(11):2365-2371.
36. Feng Y, Fang Y, Wang Y, et al (2018). Acu-point Therapy on Diabetes Mellitus and Its Common Chronic Complications: A Review of Its Mechanisms. Biomed Res Int, 2018:3128378.
37. Yang J, Liu Z (2022). Mechanistic Patho-genesis of Endothelial Dysfunction in Diabetic Nephropathy and Retinopathy. Front Endocrinol (Lausanne), 13:816400.
38. Tang G, Li S, Zhang C, et al (2021). Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management. Acta Pharm Sin B, 11(9):2749-2767.
39. Shin HR, Park K, Seo J, et al (2019). Acu-puncture for perioperative care of total hip arthroplasty: A systemic review of controlled trials and meta-analysis. Medi-cine (Baltimore), 98(15):e15198.
40. Zhang J, Yang X, Zhang X, et al (2021). Electro-Acupuncture Protects Diabetic Nephropathy-Induced Inflammation Through Suppression of NLRP3 In-flammasome in Renal Macrophage Iso-lation. Endocr Metab Immune Disord Drug Targets, 21(11):2075-2083.
41. Yue JI, Xin-Yuan ZHANG, Yun-Ming XIAO, et al (2024). Acupuncture improve proteinuria in diabetic kidney disease rats by inhibiting ferroptosis and epithe-lial-mesenchymal transition. Heliyon, 10(13):e33675.
42. Jia N, Li R, B Y, et al (2017). Effects of electroacupuncture at “Zusanli” and “Shenshu” on GLUT2 and GCK in T2DM rats. World Chinese Med, 12(5):1114–1119.
| Files | ||
| Issue | Vol 53 No 11 (2024) | |
| Section | Review Article(s) | |
| Keywords | ||
| Acupuncture Diabetic nephropathies Systematic review | ||
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How to Cite
1.
Wu C, Li Y, Piao C, Wu J. Effectiveness of Acupuncture for Diabetic Nephropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Iran J Public Health. 2024;53(11):2404-2418.
