The effects of Panax notoginseng for the treatment of diabetic nephropathy in animals: a systematic review and meta-analysis

TL;DR

This study reviews and analyzes preclinical research to evaluate how Panax notoginseng may help treat diabetic kidney disease in animals.

Contribution

This is the first comprehensive meta-analysis exploring the dose-time-response relationship of Panax notoginseng in treating diabetic nephropathy.

Findings

Panax notoginseng significantly reduced blood glucose, kidney damage markers, and inflammation in diabetic nephropathy animal models.

The herb improved oxidative stress and lipid metabolism, and reduced fibrosis markers like TGF-β1.

Optimal benefits were observed with doses of 20–200 mg/kg/d over 8–12 weeks.

Abstract

Diabetic nephropathy (DN) is a major microvascular complication of diabetes and constitutes a leading cause of end-stage renal disease (ESRD). Panax notoginseng is a widely utilized traditional Chinese medicinal herb with diverse pharmacological properties, including antioxidant, antithrombotic, and glucolipid metabolism-regulating activities. Preclinical studies have demonstrated the renoprotective effects of Panax notoginseng in DN animal models. However, a comprehensive meta-analysis of these studies is currently lacking, and the dose-time-response relationship remains unexplored.

This study aimed to systematically evaluate the efficacy of Panax notoginseng in animal models of DN and, for the first time, to explore its dose-time-response relationship. Additionally, we sought to summarize the potential mechanisms underlying its therapeutic effects on DN.

A systematic search was conducted across seven databases: PubMed, Web of Science, Embase, Chinese Biomedical Database (CBM), CNKI, WanFang, and VIP. The methodological quality of the included studies was assessed using SYRCLE’s risk of bias tool. Statistical analyses were performed using STATA 14.0 software. Primary outcomes included fasting blood glucose (FBG), serum creatinine (SCr), blood urea nitrogen (BUN), 24-h urinary protein (24 h UPro), and kidney index (KI). Secondary outcomes encompassed indicators related to inflammatory response, oxidative stress, glucose and lipid metabolism, and fibrosis. Where substantial heterogeneity was present, sensitivity and subgroup analyses were conducted to explore its sources. Publication bias was assessed via Egger’s test and funnel plots. The dose-time-response relationship of Panax notoginseng for DN was evaluated using a three-dimensional surface plot analysis.

A total of 37 studies were included in the final meta-analysis. The results demonstrated that Panax notoginseng significantly ameliorated FBG, SCr, BUN, 24 h UPro, and KI levels. Furthermore, Panax notoginseng significantly modulated key inflammatory markers, including interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein-1 (MCP-1). It also altered oxidative stress markers, such as superoxide dismutase (SOD) and malondialdehyde (MDA). In addition, Panax notoginseng exerted beneficial effects on lipid metabolism, as evidenced by reduced levels of total cholesterol (TC) and triglycerides (TG). It also attenuated the expression of the pro-fibrotic marker transforming growth factor-β1 (TGF-β1). The three-dimensional dose-time-response analysis revealed that treatment with PNS at a dosage of 20–200 mg/kg/d for 8–12 weeks conferred optimal therapeutic benefits in the DN models.

Panax notoginseng may delay the progression of DN through multiple pathways, including anti-inflammatory, antioxidant, glucolipid metabolism-regulating, and anti-fibrotic mechanisms. However, further studies are still needed to verify its efficacy and mechanisms.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420250653856.

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