Clinicopathologic features and prognostic factors in older patients with biopsy-proven diabetic nephropathy

Efficacy of Shenkang Injection combined with renin-angiotensin-aldosterone system blockers in diabetic nephropathy: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Shenkang injection (SKI), a Traditional Chinese Medicine formulation, is widely used in China for diabetic nephropathy (DN). This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SKI combined with renin-angiotensin-aldosterone system (RAAS) blockers in patients with DN.

METHODS

A comprehensive search of seven databases was conducted up to September 18, 2024, for randomized controlled trials (RCTs) comparing SKI plus RAAS blockers versus RAAS blockers alone in DN patients. Meta-analysis was performed using RevMan 5.3 and Stata 17.0, with effect sizes expressed as weighted mean differences (WMDs) or odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

A total of 18 RCTs involving 1,497 patients were analyzed. Combination therapy significantly improved total effective rate (TER) (MD 2.61, 95% CI 1.62-2.64) and reduced key renal and metabolic markers. Urinary protein excretion rate (UPER), serum creatinine (SCr), blood urea nitrogen (BUN), 24-hour urinary protein (24h-UTP), total cholesterol (TC), and triglyceride (TG) levels all significantly decreased in the combination group. Subgroup analysis showed that patients aged ≤55 years had greater reductions in SCr (WMD -25.62, 95% CI -29.41 to -21.83) and BUN (WMD -2.51, 95% CI -2.75 to -2.27). Sensitivity analysis confirmed the robustness of findings. No publication bias was detected for TER, SCr, BUN, 24h-UTP, TG, and adverse reactions, though UPER and TC showed potential bias.

CONCLUSION

SKI combined with RAAS blockers may enhance renal function and metabolic profiles in DN patients. Further high-quality RCTs are needed to validate these findings and assess long-term safety.

Auricular Point Acupressure Combined with Compound Lidocaine Cream to Manage Arteriovenous Fistula Puncture Pain: A Multicenter Randomized Controlled Trial

BACKGROUND

Arteriovenous fistula (AVF) puncture pain is an inevitable problem for maintenance hemodialysis (MHD) patients and may seriously endanger the physical and mental health of patients with MHD. Studies have shown that drug or nondrug measures can reduce AVF puncture pain, but much improvement is needed. When combined with compound lidocaine cream (CLC) in the treatment of AVF puncture pain, auricular point acupressure (APA)-a therapeutic method in which specific points on the auricle of the outer ear are stimulated to treat various disorders of the body-and the therapeutic value and synergistic effects of auriculotherapy merit further investigation.

METHODS

120 MHD patients were recruited at blood purification centers in three hospitals between January 2016 and April 2019. After completion of the baseline survey, all patients were randomly divided by the envelope method into a control group, APA group, CLC group, and APA combined with CLC, with 30 subjects per group. The numerical rating scale (NRS) of pain was used to measure the pain before intervention and 1, 4, and 8 weeks after intervention. The State-Trait Anxiety Inventory (STAI), General Comfort Questionnaire (GCQ), blood pressure, and heart rates were obtained before and after the intervention.

RESULTS

Pain, anxiety, comfort, blood pressure (BP), and heart rates (HR) of the three groups were better than those of the control group; the difference was statistically significant (P < 0.05). In addition, the APA combined with CLC group was better than the APA group and CLC group, respectively, in those outcomes (P < 0.05).

CONCLUSION

Both APA and CLC can effectively relieve AVF puncture pain, and the combined application has more outstanding effects.