# Comparative effectiveness of traditional Chinese medicine injections combined with ACEI/ARB for diabetic nephropathy: A systematic review and network meta-analysis

## TL;DR

This study compares traditional Chinese medicine injections combined with standard drugs for treating diabetic kidney disease, finding some may improve key health markers.

## Contribution

A network meta-analysis evaluating the effectiveness of various traditional Chinese medicine injections combined with ACEI/ARB for diabetic nephropathy.

## Key findings

- Shuxuetong and Shenkang injections were most effective for reducing urinary albumin excretion rate and serum creatinine.
- Danshen injection showed the highest total effective rate and improved blood urea nitrogen levels.
- Some TCM injections demonstrated varying degrees of adverse reactions, while others like Huangqi and Gegensu showed no significant side effects.

## Abstract

This systematic review and network meta-analysis aimed to evaluate the comparative effectiveness of traditional Chinese medicine injections (TCMIs) combined with angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers for diabetic nephropathy (DN).

Ten databases were searched. Primary endpoint indicators were urinary albumin excretion rate (UAER) and serum creatinine (Scr). Secondary endpoint indicators were blood urea nitrogen (BUN), urinary β2-microglobulin, total cholesterol, triglyceride, systolic blood pressure, and total effective rate. Cochrane risk of bias tool (version 2.0) was used to evaluate the quality of the studies. The GRADE method was used to assess the whole network. Finally, Stata 16.0 software was used to perform network meta-analysis.

A total of 99 randomised controlled trials and ten TCMIs were included for analysis. Based on the surface under the cumulative ranking curve values, it was observed that the efficacy of the combination group was better than that of the control group. For the primary endpoints, the Shuxuetong and Shenkang injections were excellent in reducing UAER and Scr, respectively. The Danshen injection was the most effective for the total effective rate and BUN; the Shuxuetong, Yinxingdamo, Danshen-Chuanxiongqin, and Shuxuening injections were the most effective for total cholesterol, β2-microglobulin, triglyceride, and systolic blood pressure, respectively. In terms of dual indicators, for UAER and Scr, the Danshen injection may be the most effective treatment. In addition, no significant adverse reactions were reported in the relevant studies on the Huangqi and Gegensu injections, whereas the Yinxingdamo, Danshen-Chuanxiongqin, Shenkang, Shuxuetong, and Kudiezi injections demonstrated varying degrees of adverse reactions.

In this study, it is indicated that when combined with ACEI/ARB, the Shuxuetong, Shenkang, Danshen, Danshen-Chuanxiongqin, Yinxingdamo, and Shuxuening injections may confer advantages in improving DN indicators. However, due to limitations in the methodological quality of the included studies (especially deficiencies in randomisation and blinding) and the critical lack of reporting on key information regarding TCMI components, the reliability of these findings is compromised.