Efficacy and Safety of Sodium Tanshinone IIA Sulfonate Injection on Hypertensive Nephropathy: A Systematic Review and Meta-Analysis

Abstract

Background: Sodium tanshinone IIA sulfonate (STS) injection, the extractive of traditional Chinese medicine Danshen, is supposed to be a supplementary treatment in hypertensive nephropathy. Objectives: To evaluate the efficacy and safety of STS in treatment of hypertensive nephropathy. Methods: We systematically searched China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang database, Chinese Biomedicine Database (CBM), PubMed, Embase, Web of Science, and Cochrane Library from their inception to December 2018. All studies were screened by two reviewers according to the inclusion and exclusion criteria independently. The Cochrane Collaboration's risk tool was used to assess the methodological quality of the included studies. Reviewer Manager 5.3 was employed for statistical analysis. Results: Sixteen trials involving 1,696 patients were included. The meta-analysis results indicated a combination of STS and angiotensin receptor blockers (ARBs) was more effective than ARB monotherapy in modulating hypertensive nephropathy, as represented by improved estimated glomerular filtration rate (eGFR) [mean difference (MD) = 6.87, 95% CI (4.47, 9.28), P < 0.00001] and reduced 24 h urinary protein [MD = −0.23, 95% CI (−0.27, −0.19), P < 0.00001], serum creatinine (SCr) [MD = −21.74, 95% CI (−24.11, −19.38), P < 0.00001], cystatin-C [MD = −0.16, 95% CI (−0.24, −0.07), P = 0.0003], urinary immunoglobulin G (IgG) [MD = −0.85, 95% CI (−1.11, −0.59), P < 0.00001], and urinary transferrin [MD = −0.61, 95% CI (−1.04, −0.17), P = 0.007]. In addition, the combination therapy had better control in systolic blood pressure (SBP) [MD = −6.53, 95% CI (−8.19, −4.87), P < 0.00001] and diastolic blood pressure (DBP) [MD = −4.14, 95% CI (−5.69, −2.59), P < 0.00001]. Only three trials reported adverse events, and no adverse drug reactions were observed.

Combined therapy of hypertensive nephropathy with ginkgo leaf extract and dipyridamole injection and antihypertensive drugs

“…GDI has the functions of expanding renal blood vessels, enhancing renal blood flow, improving renal microcirculation, blocking renal fibrosis, reducing Scr, BUN, etc. [ 34 ] The combination of GDI with conventional therapy may have a synergistic effect of reducing Scr through above mechanisms. In addition, we found the combination treatment can improve the Ccr, MAP, and clinical efficacy of patients with hypertensive renal damage.…”

Targeting Oxidative Stress and Endothelial Dysfunction Using Tanshinone IIA for the Treatment of Tissue Inflammation and Fibrosis

“…Sanghuang–Danshen, a mixture of drugs containing TanIIA, reduced blood pressure and arterial stiffness in healthy smokers [ 144 ]. A recent meta-analysis revealed that TanIIA reduces blood pressure in patients with hypertensive nephropathy and improves renal function due to cardiac-renal crosstalk [ 145 ]. As detailed in the previous sections, cell and animal studies suggest that the antioxidative, anti-inflammatory, and antifibrotic effects of TanIIA may be the major contributing factors to its protective effect.…”

New Insights Into the Effects of Individual Chinese Herbal Medicines on Chronic Kidney Disease

“…Sixteen clinical trials involving 1,696 patients were included in this meta-analysis. It was interestingly found that a combination of Tanshinone IIA (TIIA) and angiotensin receptor blockers (ARBs) was more effective than ARB monotherapy in modulating hypertensive nephropathy ( Xu, et al, 2019 ). This was indicated by improved eGFR and reduced urinary protein, serum creatinine, cystatin-C, and better control in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in group combined with STS plus ARBs than in ARBs alone group.…”