Chronic kidney disease (CKD) is a long-term, life threatening illness that is becoming more common. People who have CKD are monitored closely and treated with therapies that are determined according to the stage of their illness and whether they have other health problems. Treatment for CKD often involves drugs to control blood pressure and aid kidney function - often angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) - along with restricting the amount of protein consumed. Practitioners of traditional Chinese medicine often use Rheum officinale (Da Huang, a type of rhubarb) to treat people with CKD.
We analysed evidence from nine studies conducted in China that compared Rheum officinale with no treatment or treatment with captopril, an ACEi. We looked at reported changes in two important blood markers - serum creatinine and blood urea nitrogen - that indicate progression of CKD.
We found no high quality evidence to indicate that treatment with Rheum officinale can improve CKD or delay its progression. Rheum officinale was not found to cause any serious health problems in patients with CKD. Well-designed randomised controlled studies are needed to provide robust, high quality evidence to assess if there are benefits from Rheum officinale for people with CKD.
Currently available evidence concerning the efficacy of Rheum officinale to improve SCr and BUN levels in patients with CKD is both scant and low quality. Although Rheum officinale does not appear to be associated with serious adverse events among patients with CKD, there is no current evidence to support any recommendation for its use.
Chronic kidney disease (CKD) is a major public health issue worldwide. Standard therapies to delay CKD progression include dietary protein restriction and administration of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) to help control blood pressure and confer additional renoprotective effects. Despite such interventions, CKD incidence and mortality rates continue to increase. Rheum officinale (Da Huang) a medicinal herb used widely in China to treat CKD has been reported to offer a range of pharmacological properties that may delay disease progression.
To assess the benefits and harms of Rheum officinale for preventing the progression of CKD.
We searched the Cochrane Renal Group's Specialised Register (up to 27 May 2015) through contact with the Trials' Search Co-ordinator using search terms relevant to this review.
We included randomised controlled trials (RCTs) and quasi-RCTs that assessed the benefits and harms of Rheum officinale for preventing the progression of CKD regardless of dosage, type, maturity, mode of administration, duration of treatment, or storage time before use.
Two authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We expressed results for dichotomous outcomes (need for renal replacement therapy, all-cause mortality, quality of life) as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes (glomerular filtration rate (GFR), serum creatinine (SCr), creatinine clearance (CrCl), blood urea nitrogen (BUN)) were expressed as mean differences (MD) with 95% CIs.
We identified nine studies that enrolled 682 participants. None of the studies reported blinding or group allocation methods. Seven studies were judged to be at low risk of incomplete outcome reporting; three studies were judged to be a low risk of selective reporting (protocols were available and/or all outcomes relevant to the this review were reported); and two studies were judged free of other potential biases.
Seven studies compared Rheum officinale with no treatment and two made comparisons with captopril, an angiotensin-converting enzyme inhibitor (ACEi). Compared with no treatment, Rheum officinale had a positive effect on SCr (MD -87.49 µmol/L, 95% CI -139.25 to -35.72) and BUN (MD -10.61 mmol/L, 95% CI -19.45 to -2.21). Compared with captopril, a statistically significant difference was not demonstrated in relation to Rheum officinale for any outcome (BUN, CrCl, or patients' capacity to undertake work). No data were available on all-cause mortality or cost of treatment. Only minor adverse events were reported in association with Rheum officinale.