Teo Wei Yi, Chu Shu Wen Felicia, Chow Li Yue, Yeam Cheng Teng, Low Lian Leng, Quah Joanne Hui Min, Foo Marjorie, Seng Jun Jie Benjamin
Biological Sciences, National University of Singapore, Singapore, SGP.
Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP.
Cureus. 2022 Dec 23;14(12):e32874. doi: 10.7759/cureus.32874. eCollection 2022 Dec.
There is a growing interest in the use of alternative medical systems (AMS), such as traditional Chinese medicine (TCM), ayurveda, homeopathy, and naturopathy, among chronic kidney disease patients. This review summarizes the efficacy and safety of AMS interventions in chronic kidney disease (CKD) patients. A systematic review was conducted in MEDLINE, Embase, Scopus, CINAHL, CENTRAL, and PsycINFO in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. Randomized controlled trials (RCTs) which evaluated the use of AMS among adult CKD patients were included. The efficacy of each AMS was assessed based on improvement in biochemical markers or reduction in symptom severity scores. All adverse reactions were recorded. Of the 14,583 articles retrieved, 33 RCTs were included. TCM (n=20) and ayurveda (n=6) were the most well-studied. Majority of studies (66.7%) had a sample size <100. Common indications evaluated included improvement in renal function (n=12), proteinuria (n=5), and uremic pruritus (n=5). Among TCM, acupuncture and syndromes-based TCM granules formulation were shown to improve estimated glomerular filtration rate (eGFR) by 5.1-15.5% and 7.07-8.12% respectively. Acupuncture reduced uremic pruritus symptoms by 54.7-60.2% while Huangkui, Shenqi granules, and Hook F reduced proteinuria by 18.6-50.7%, 61.8%, and 32.1% respectively. For Ayurveda, camel milk and oil improved eGFR by 16.9% and 86.8%, respectively, while capsaicin reduced pruritus scores by 84.3%. Homeopathic verum medication reduced pruritus scores by 29.2-41.5%. Nausea was the most common adverse effect reported with alpha-keto amino acids (0.07%), oil (7.04%), and silymarin (10%). TCM and ayurveda were more well-studied AMS therapies that demonstrated efficacy in CKD patients. RCTs with larger sample sizes are needed to ascertain the efficacy and safety of promising AMS.
慢性肾脏病患者对使用替代医学系统（AMS），如传统中医（TCM）、阿育吠陀医学、顺势疗法和自然疗法的兴趣日益浓厚。本综述总结了AMS干预措施对慢性肾脏病（CKD）患者的疗效和安全性。根据系统评价和Meta分析的首选报告项目（PRISMA）以及非Meta分析的综合（SWiM）指南，在MEDLINE、Embase、Scopus、CINAHL、CENTRAL和PsycINFO中进行了系统评价。纳入了评估成人CKD患者使用AMS的随机对照试验（RCT）。根据生化指标的改善或症状严重程度评分的降低来评估每种AMS的疗效。记录所有不良反应。在检索到的14583篇文章中，纳入了33项RCT。研究最多的是中医（n = 20）和阿育吠陀医学（n = 6）。大多数研究（66.7%）的样本量<100。评估的常见适应症包括肾功能改善（n = 12）、蛋白尿（n = 5）和尿毒症瘙痒（n = 5）。在中医方面，针灸和基于证型的中药颗粒制剂分别使估计肾小球滤过率（eGFR）提高了5.1 - 15.5%和7.07 - 8.12%。针灸使尿毒症瘙痒症状减轻了54.7 - 60.2%，而黄葵、参芪颗粒和钩藤分别使蛋白尿减少了18.6 - 50.7%、61.8%和32.1%。对于阿育吠陀医学，骆驼奶和油分别使eGFR提高了16.9%和86.8%，而辣椒素使瘙痒评分降低了84.3%。顺势疗法真药使瘙痒评分降低了29.2 - 41.5%。恶心是α - 酮氨基酸（0.07%）、油（7.04%）和水飞蓟宾（10%）报告的最常见不良反应。中医和阿育吠陀医学是研究较多的AMS疗法，在CKD患者中显示出疗效。需要更大样本量的RCT来确定有前景的AMS的疗效和安全性。
