Pentoxifylline for diabetic kidney disease

Dan Shan; Hong Mei Wu; Qi Yuan Yuan; Jun Li; Rong Le Zhou; Guan J Liu

doi:10.1002/14651858.CD006800.pub2

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Figure 1

Study flow diagram: pentoxifylline for diabetic kidney disease (DKD)

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 1 Serum creatinine at end of treatment.

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Analysis 1.2

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 2 Creatinine clearance at end of treatment.

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Analysis 1.3

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 3 Albuminuria at end of treatment.

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Analysis 1.4

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 4 Overt proteinuria at end of treatment.

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Analysis 1.5

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 5 Systolic BP at end of treatment.

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Analysis 1.6

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 6 Diastolic BP at end of treatment.

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Analysis 1.7

Comparison 1 Pentoxifylline + routine treatment versus placebo + routine treatment, Outcome 7 Any adverse events at end of treatment.

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Analysis 2.1

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 1 Serum creatinine at end of treatment.

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Analysis 2.2

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 2 Change in albuminuria.

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Analysis 2.3

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 3 Change in proteinuria.

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Analysis 2.4

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 4 Systolic BP at end of treatment.

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Analysis 2.5

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 5 Diastolic BP at end of treatment.

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Analysis 2.6

Comparison 2 Pentoxifylline + routine treatment versus routine treatment, Outcome 6 Any adverse events at end of treatment.

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Analysis 3.1

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 1 Serum creatinine at end of treatment.

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Analysis 3.2

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 2 Creatinine clearance at end of treatment.

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Analysis 3.3

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 3 Albuminuria at end of treatment.

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Analysis 3.4

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 4 Proteinuria at end of treatment.

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Analysis 3.5

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 5 Systolic BP at end of treatment.

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Analysis 3.6

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 6 Diastolic BP at end of treatment.

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Analysis 3.7

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 7 Plasma fibrinogen at end of treatment.

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Analysis 3.8

Comparison 3 Pentoxifylline + routine treatment versus other drugs + routine treatment, Outcome 8 Adverse events at end of treatment.

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Comparison 1. Pentoxifylline + routine treatment versus placebo + routine treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Serum creatinine at end of treatment Show forest plot	2	117	Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.17, ‐0.03]

2 Creatinine clearance at end of treatment Show forest plot	1	94	Mean Difference (IV, Random, 95% CI)	‐5.18 [‐15.55, 5.18]

2.1 Type 2 microalbuminuria	1	30	Mean Difference (IV, Random, 95% CI)	‐12.0 [‐27.42, 3.42]
2.2 Type 2 proteinuria	1	22	Mean Difference (IV, Random, 95% CI)	‐1.0 [‐21.66, 19.66]
2.3 Type 1 albuminuria	1	18	Mean Difference (IV, Random, 95% CI)	2.0 [‐21.59, 25.59]
2.4 Type 1 proteinuria	1	24	Mean Difference (IV, Random, 95% CI)	1.0 [‐31.19, 33.19]
3 Albuminuria at end of treatment Show forest plot	2	117	Std. Mean Difference (IV, Random, 95% CI)	‐2.28 [‐3.85, ‐0.70]

4 Overt proteinuria at end of treatment Show forest plot	1	46	Mean Difference (IV, Random, 95% CI)	‐428.58 [‐661.65, ‐195.50]

4.1 Type 2 proteinuria	1	22	Mean Difference (IV, Random, 95% CI)	‐552.0 [‐656.57, ‐447.43]
4.2 Type 1 proteinuria	1	24	Mean Difference (IV, Random, 95% CI)	‐314.0 [‐367.36, ‐260.64]
5 Systolic BP at end of treatment Show forest plot	2	126	Mean Difference (IV, Random, 95% CI)	‐1.29 [‐11.80, 9.23]

5.1 Type 2 microalbuminuria	2	62	Mean Difference (IV, Random, 95% CI)	10.15 [‐15.27, 35.58]
5.2 Type 2 proteinuria	1	22	Mean Difference (IV, Random, 95% CI)	5.0 [‐4.19, 14.19]
5.3 Type 1 microalbuminuria	1	18	Mean Difference (IV, Random, 95% CI)	‐6.0 [‐11.08, ‐0.92]
5.4 Type 1 proteinuria	1	24	Mean Difference (IV, Random, 95% CI)	‐22.0 [‐31.41, ‐12.59]
6 Diastolic BP at end of treatment Show forest plot	2	126	Mean Difference (IV, Random, 95% CI)	‐5.75 [‐9.56, ‐1.94]

6.1 Type 2 microalbuminuria	2	62	Mean Difference (IV, Random, 95% CI)	‐3.17 [‐7.98, 1.64]
6.2 Type 2 proteinuria	1	22	Mean Difference (IV, Random, 95% CI)	‐1.0 [‐8.07, 6.07]
6.3 Type 1 microalbuminuria	1	18	Mean Difference (IV, Random, 95% CI)	‐9.0 [‐14.55, ‐3.45]
6.4 Type 1 proteinuria	1	24	Mean Difference (IV, Random, 95% CI)	‐11.0 [‐18.23, ‐3.77]
7 Any adverse events at end of treatment Show forest plot	2	83	Risk Difference (M‐H, Random, 95% CI)	0.10 [‐0.10, 0.30]

Comparison 1. Pentoxifylline + routine treatment versus placebo + routine treatment

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Comparison 2. Pentoxifylline + routine treatment versus routine treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Serum creatinine at end of treatment Show forest plot	5	199	Mean Difference (IV, Random, 95% CI)	0.00 [‐0.06, 0.07]

2 Change in albuminuria Show forest plot	4	220	Std. Mean Difference (IV, Random, 95% CI)	0.62 [0.18, 1.07]

3 Change in proteinuria Show forest plot	5	192	Mean Difference (IV, Random, 95% CI)	0.46 [0.17, 0.74]

4 Systolic BP at end of treatment Show forest plot	5	240	Mean Difference (IV, Random, 95% CI)	‐0.28 [‐2.20, 1.63]

5 Diastolic BP at end of treatment Show forest plot	5	240	Mean Difference (IV, Random, 95% CI)	‐0.15 [‐1.44, 1.14]

6 Any adverse events at end of treatment Show forest plot	3	190	Risk Difference (M‐H, Random, 95% CI)	0.11 [‐0.01, 0.22]

Comparison 2. Pentoxifylline + routine treatment versus routine treatment

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Comparison 3. Pentoxifylline + routine treatment versus other drugs + routine treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Serum creatinine at end of treatment Show forest plot	2	166	Mean Difference (IV, Random, 95% CI)	‐0.00 [‐0.08, 0.07]

2 Creatinine clearance at end of treatment Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Compared with ACEi	2	145	Mean Difference (IV, Random, 95% CI)	3.26 [‐1.05, 7.58]
2.2 Compared with clonidine or methyldopa	1	21	Mean Difference (IV, Random, 95% CI)	10.90 [1.40, 20.40]
3 Albuminuria at end of treatment Show forest plot	2	233	Mean Difference (IV, Random, 95% CI)	‐8.79 [‐27.18, 9.59]

4 Proteinuria at end of treatment Show forest plot	2	145	Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.03, 0.01]

5 Systolic BP at end of treatment Show forest plot	3	272	Mean Difference (IV, Random, 95% CI)	1.46 [‐0.57, 3.50]

6 Diastolic BP at end of treatment Show forest plot	3	272	Mean Difference (IV, Random, 95% CI)	1.37 [‐0.23, 2.98]

7 Plasma fibrinogen at end of treatment Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

8 Adverse events at end of treatment Show forest plot	2	166	Risk Difference (M‐H, Random, 95% CI)	‐0.07 [‐0.15, 0.01]

Comparison 3. Pentoxifylline + routine treatment versus other drugs + routine treatment

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