Supriyadi R, Koswara M I A, Soelaeman M A, Huang I
Department of Internal Medicine, Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
Eur Rev Med Pharmacol Sci. 2023 Feb;27(4):1413-1426. doi: 10.26355/eurrev_202302_31379.
This systematic review and meta-analysis aimed to address the effect of antioxidant supplementation on oxidative stress and proinflammatory biomarkers in patients with Chronic Kidney Disease (CKD).
Systematic literature searches from the date of inception up to September 16th, 2022, were performed on PubMed, SCOPUS, and the Cochrane Central Register of Controlled Trials using relevant keywords, i.e., "Chronic Kidney Disease" and "antioxidants", and "supplementation". All studies relevant to the selection criteria were included in the analysis, focusing on any type of oxidative stress and proinflammatory biomarkers. A meta-analysis of included literature was conducted if sufficient data was obtained.
This systematic review involved 32 published studies, with most having a Jadad score of ≥ 3 (65.6%). Only studies on antioxidants, i.e., polyphenols (n=5) and vitamin E (n=6) in curcumin/turmeric, were sufficient to be included in a meta-analysis. Curcumin/turmeric supplementation was found to significantly reduce the serum c-reative protein (CRP) [standardized mean difference (SMD) -0.5238 (95% CI: -1.0495, 0.0019); p = 0.05; I2 = 78%; p = 0.001]. Similarly, vitamin E supplementation was found to significantly reduce the serum CRP [SMD -0.37 (95% CI: -0.711, -0.029); p = 0.03; I2= 53%; p = 0.06] , but not serum interleukin-6 (IL-6) [SMD -0.26 (95% CI: -0.68, 0.16); p = 0.22; I2 = 43%; p = 0.17] and malondialdehyde (MDA) content [SMD -0.94 (95% CI: -1.92, 0.04); p = 0.06; I2= 87%; p = 0.0005].
Our review suggests that curcumin/turmeric and vitamin E supplements effectively lower serum CRP levels in CKD patients, particularly those undergoing chronic dialysis (CKD-5D). Higher scales of randomized controlled trials (RCTs) are still needed for other antioxidants due to inconclusive and contradicting results.
本系统评价和荟萃分析旨在探讨补充抗氧化剂对慢性肾脏病（CKD）患者氧化应激和促炎生物标志物的影响。
在PubMed、SCOPUS和Cochrane对照试验中央注册库中，使用相关关键词，即“慢性肾脏病”、“抗氧化剂”和“补充剂”，从数据库建立之日至2022年9月16日进行系统文献检索。所有符合入选标准的研究均纳入分析，重点关注任何类型的氧化应激和促炎生物标志物。如果获得足够的数据，则对纳入文献进行荟萃分析。
本系统评价纳入了32项已发表的研究，大多数研究的Jadad评分≥3（65.6%）。只有关于抗氧化剂的研究，即姜黄素/姜黄中的多酚（n = 5）和维生素E（n = 6），足以纳入荟萃分析。发现补充姜黄素/姜黄可显著降低血清C反应蛋白（CRP）[标准化均值差（SMD）-0.5238（95%CI：-1.0495，0.0019）；p = 0.05；I2 = 78%；p = 0.001]。同样，发现补充维生素E可显著降低血清CRP[SMD -0.37（95%CI：-0.711，-0.029）；p = 0.03；I2 = 53%；p = 0.06]，但不能降低血清白细胞介素-6（IL-6）[SMD -0.26（95%CI：-0.68，0.16）；p = 0.22；I2 = 43%；p = 0.17]和丙二醛（MDA）含量[SMD -0.94（95%CI：-1.92，0.04）；p = 0.06；I2 = 87%；p = 0.0005]。
我们的综述表明，姜黄素/姜黄和维生素E补充剂可有效降低CKD患者的血清CRP水平，尤其是那些接受慢性透析的患者（CKD-5D）。由于结果不确定且相互矛盾，其他抗氧化剂仍需要更高规模的随机对照试验（RCT）。
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