The Effects of Rhubarb for the Treatment of Diabetic Nephropathy in Animals: A Systematic Review and Meta-analysis

Zeng, Jing-Yi; Wang, Yu; Miao, Miao; Bao, Xiaoyong

doi:10.3389/fphar.2021.602816

Cited by 16 publications

(8 citation statements)

References 40 publications

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“…The initial search yielded 740 relevant records (145 from CBM, 271 from CNKI, 151 from VIP and 173 from Wanfang). NoteExpress software was used for de-weighting, and the exclusion of ineligible papers was carried out according to the pre-designed de-weighting criteria, and a total of 34 papers were finally identified for inclusion ( Yokozawa et al, 1986 ; Duan, 2005 ; Gao, 2005 ; Zhang, 2005 ; Chang, 2006 ; Chen and Diao, 2008 ; Liu and Feng, 2008 ; Sun, 2008 ; Yuan, 2008 ; Cao, 2009 ; Chen, 2009 ; Dan, 2009 ; Rai, 2009 ; Xue, 2009 ; Hang, 2010 ; Jing, 2010 ; Liu, 2010 ; Liu and Li, 2012 ; Ma et al, 2012 ; Zeng, 2012 ; Han, 2013 ; Wang and Sun, 2015 ; Yan, 2015 ; Qin, 2016 ; Williams and Heller, 2016 ; Li et al, 2017 ; Zhang et al, 2018 ; Xue et al, 2019 ; Yu, 2019 ; Gong et al, 2020 ; Jin, 2020 ; Yang, 2020 ; Zeng et al, 2021 ) ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…ex Regel ) Balf ., ( The Angiosperm Phylogeny Group et al, 2016 ). Rhubarb has been applied in the treatment of CRF in recent years with remarkable clinical efficacy ( Zeng et al, 2021 ). Previous studies have suggested that rhubarb treats chronic renal failure mainly as a laxative, causing uremic toxins to be excreted from the bowels via the intestines ( Yokozawa et al, 1986 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical effect of rhubarb on the treatment of chronic renal failure: A meta-analysis

Huang

Rao

et al. 2023

Front. Pharmacol.

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Objective: 1) To evaluate the effificacy of rhubarb in the treatment of chronic renal failure (CRF); 2) To explore the safety for rhubarb-based therapy on chronic renal failure.Methods: The randomized and semi randomized controlled trials of Rhubarb in the treatment of chronic renal failure in medical electronic databases (up to September 2021) were searched, and meta-analysis was carried out by revman 5.3 software.Results: A total of 2,786 patients were included in 34 literatures, including 1,474 cases in the treatment group and 1,312 cases in the control group. The results of meta-analysis showed that Serum creatinine (SCR) [MD = 123.57, 95% Cl (111.59, 131.96)], Blood urea nitrogen (BUN) [MD = −3.26, 95% Cl (−4.22,−2.31)], Creatinine clearance rate (CCR) [MD = 3.95, 95% Cl (−0.03, 7.93)], Hemoglobin (Hb) [MD = 7.70, 95% Cl (−0.18, 15.58)] and Uric acid (UA) [MD = −42.79, 95% CI (−66.29, −19.29)]. The total effective rate of improving symptoms and signs in chronic renal failure patients [Peto or = 4.14, 95% Cl (3.32, 5.16)].Conclusion: This systematic review and meta-analysis demonstrated that rhubarb has a positive therapeutic effect, which may provide confifidence and some theoretical reference for clinical application to a certain extent. Compared with the control group, rhubarb alone or traditional Chinese medicine compound containing Rhubarb can significantly reduce Serum creatinine, Blood urea nitrogen and Uric acid, increase Creatinine clearance rate, and improve the total effective rate of symptoms and signs. However, there is no evidence that rhubarb is more effective than the control group in increasing hemoglobin. In addition, due to the low quality of research methodology in the included literature, it is necessary to further study high-quality literature to evaluate its efficacy and safety.Systematic Review Registration:https://inplasy.com/inplasy-2021-10-0052/, identifier INPLASY2021100052.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical effect of rhubarb on the treatment of chronic renal failure: A meta-analysis

Huang

Rao

et al. 2023

Front. Pharmacol.

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“…In the bioactive fraction of ethyl acetate extract of SKI, we identified three anthraquinones including chrysophanol, emodin, and rhein that were major and bioactive components of Rheum officinale , which has been demonstrated to improve CKD and renal fibrosis ( Wang et al, 2012 ; Zhang et al, 2018 ; Zeng et al, 2021 ). Compared with chrysophanol and emodin, rhein showed a strong inhibitory effect on renal fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Shenkang Injection and Its Three Anthraquinones Ameliorates Renal Fibrosis by Simultaneous Targeting IƙB/NF-ƙB and Keap1/Nrf2 Signaling Pathways

Luo

Suo²,

Ren³

et al. 2021

Front. Pharmacol.

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Oxidative stress and inflammation are important and critical mediators in the development and progression of chronic kidney disease (CKD) and its complications. Shenkang injection (SKI) has been widely used to treat patients with CKD. Although the anti-oxidative and anti-inflammatory activity was involved in SKI against CKD, its bioactive components and underlying mechanism remain enigmatic. A rat model of adenine-induced chronic renal failure (CRF) is associated with, and largely driven by, oxidative stress and inflammation. Hence, we identified the anti-oxidative and anti-inflammatory components of SKI and further revealed their underlying mechanism in the adenine-induced CRF rats. Compared with control rats, the levels of creatinine, urea, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol in serum were significantly increased in the adenine-induced CRF rats. However, treatment with SKI and its three anthraquinones including chrysophanol, emodin, and rhein could reverse these aberrant changes. They could significantly inhibit pro-fibrotic protein expressions including collagen I, α-SMA, fibronectin, and vimentin in the kidney tissues of the adenine-induced CRF rats. Of note, SKI and rhein showed the stronger inhibitory effect on these pro-fibrotic protein expressions than chrysophanol and emodin. Furthermore, they could improve dysregulation of IƙB/NF-ƙB and Keap1/Nrf2 signaling pathways. Chrysophanol and emodin showed the stronger inhibitory effect on the NF-κB p65 protein expression than SKI and rhein. Rhein showed the strongest inhibitory effect on p65 downstream target gene products including NAD(P)H oxidase subunits (p47phox, p67phox, and gp91phox) and COX-2, MCP-1, iNOS, and 12-LO in the kidney tissues. However, SKI and rhein showed the stronger inhibitory effect on the significantly downregulated anti-inflammatory and anti-oxidative protein expression nuclear Nrf2 and its target gene products including HO-1, catalase, GCLC, and NQO1 in the Keap1/Nrf2 signaling pathway than chrysophanol and emodin. This study first demonstrated that SKI and its major components protected against renal fibrosis by inhibiting oxidative stress and inflammation via simultaneous targeting IƙB/NF-ƙB and Keap1/Nrf2 signaling pathways, which illuminated the potential molecular mechanism of anti-oxidative and anti-inflammatory effects of SKI.

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“…was observed in the last three months by curcumin supplementation [94]. Rhubarb is one of the most important natural products and is usually used for treating renal diseases [95][96][97][98]. Treatment with rhubarb enema could decrease the levels of trimethylamine N-oxide and trimethylamine in serum, suppress the expression of interleukin-6, tumour necrosis factor α and interferon-γ and mitigate tubular atrophy, inflammatory cell infiltration and tubulointerstitial fibrosis in the 5/6 nephrectomized rats [82].…”

Section: Intervention Strategies Through Regulating Gut Microbiota In...mentioning

confidence: 99%

Recent advances of gut microbiota in chronic kidney disease patients

Zhao

2022

Exploration of Medicine

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Chronic kidney disease (CKD) is a worldwide public health issue and has ultimately progressed to an end-stage renal disease that requires life-long dialysis or renal transplantation. However, the underlying molecular mechanism of these pathological development and progression remains to be fully understood. The human gut microbiota is made up of approximately 100 trillion microbial cells including anaerobic and aerobic species. In recent years, more and more evidence has indicated a clear association between dysbiosis of gut microbiota and CKD including immunoglobulin A (IgA) nephropathy, diabetic kidney disease, membranous nephropathy, chronic renal failure and end-stage renal disease. The current review describes gut microbial dysbiosis and metabolites in patients with CKD thus helping to understand human disease. Treatment with prebiotics, probiotics and natural products can attenuate CKD through improving dysbiosis of gut microbiota, indicating a novel intervention strategy in patients with CKD. This review also discusses therapeutic options, such as prebiotics, probiotics and natural products, for targeting dysbiosis of gut microbiota in patients to provide more specific concept-driven therapy strategy for CKD treatment.

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The Effects of Rhubarb for the Treatment of Diabetic Nephropathy in Animals: A Systematic Review and Meta-analysis

Cited by 16 publications

References 40 publications

Clinical effect of rhubarb on the treatment of chronic renal failure: A meta-analysis

Clinical effect of rhubarb on the treatment of chronic renal failure: A meta-analysis

Shenkang Injection and Its Three Anthraquinones Ameliorates Renal Fibrosis by Simultaneous Targeting IƙB/NF-ƙB and Keap1/Nrf2 Signaling Pathways

Recent advances of gut microbiota in chronic kidney disease patients

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