Efficacy and Safety of Flos Abelmoschus Manihot(Malvaceae) on Type 2 Diabetic Nephropathy:A Systematic Review

Objective:To evaluate the efficacy and safety of Flos Abelmoschus manihot(Malvaceae) on type 2 diabetic nephropathy(DN).Methods:The Cochrane Library,PubMed/MEDLINE,Excerpta Medical Database,Chinese electronic literature databases,and the references of relevant articles were searched in March 2012 for randomized controlled trials(RCTs) that reported the effects of Flos A.manihot on type 2 DN patients with overt but subnephrotic-range proteinuria(500-3,500 mg/24 h).The quality of trials was evaluated using the Cochrane-recommended method.The results were summarized as risk ratios(RRs) for dichotomous outcomes or mean differences(MDs) for continuous outcomes.Results:Seven trials(531 patients) were included.Flos A.manihot significantly decreased proteinuria[MD-317.32 mg/24 h,95%confidence interval(CI)[-470.48,-164.17],P<0.01].After excluding a trial that only included patients with well-preserved renal function,Flos A.manihot was associated with a significant decrease in serum creatinine(MD-11.99 μ mol/L,95%CI[-16.95,-7.04],P<0.01).Serious adverse events were not observed.The most common adverse event was mild to moderate gastrointestinal discomfort;however,patients receiving this herb did not have an increased risk for tolerated gastrointestinal discomfort(RR 1.48,95%CI[0.39,5.68],P=0.57).Conclusions:Flos A.manihot may be considered as an important adjunctive therapy with the first-line and indispensable therapeutic strategies for type 2 DN.High-quality RCTs are urgently needed to confirm the effect of Flos A.manihot on definite endpoints such as end-stage renal disease.