| Diabetic kidney disease is one of the most common diabetic microvascular complications. With the increasing incidence of diabetes, the morbidity of diabetic kidney disease are higher. In developed countries, diabetic kidney disease is the leading cause of end stage renal disease that about 50% of end-stage renal disease caused by DKD and DKD is often complicated with cardiovascular disease and ultimately develops to the end-stage renal disease (ESRD), with quite expensive costs. So it is known as "the world disaster of medicine".Traditional Chinese medicine in the treatment of diabetic kidney disease has a history of thousands of years. It has achieved a certain effect, which has obvious advantages in improving the symptoms of patients, reducing proteinuria and protecting the renal function in the past decades. Doctors has summed up their unique treatment methods according to the DKD related researches and their clinical experience, using extracts of traditional Chinese medicine, classical prescriptions, self-made prescriptions or proprietary Chinese medicine as a complementary and alternative therapy in the treatment of patients with DKD. With the continuous rising fever of clinical trails on the traditional Chinese medicine treatment of DKD, the number of related research reports is also increasing, and the clinical curative effect is remarkable. In order to further evaluate the effectiveness and safety of traditional Chinese medicine in the treatment of DKD, it is necessary to carry out the systematic reviews on effectiveness and safety of traditional Chinese medicine in the treatment of DKD. In order to understand the research progress of evidence-based medicine in the field of traditional Chinese medicine treatment of DKD, and to improve the quality of evidence based medicine. First of all, we have evaluated the characteristics of the systematic reviews in this field from the epidemiology, quality and reporting characteristics in order to improve the quality of the evidence in this systematic review.Objective:1. By evaluating the epidemiology, quality and reporting characteristics of published systematic reviews of Chinese medicine treatment of DKD, to getting more acquainted with the progress of evidence-based medicine research in this field and improve the reporting and methodological quality of systematic reviews in the future2. To evaluate the efficacy and safety of traditional Chinese medicine in the treatment of DKD, and provide high quality evidence for the treatment of DKD with traditional Chinese medicine.Methods1.Researching for systematic reviewes/meta analyses of TCM in the treatment of DKD in databases Cochrane library,pubmed, CNKI, VIP, sinomed and wanfang(Date: each database construction to 2015.10) and applying the PRISMA checklist and AMSTAR checklist to evaluate their epidemiology, quality and reporting characteristics.2..Researching for RCTS of TCM in the treatment of DKD in databases Cochrane library,pubmed, EMBASE, MEDLINE CNKI, VIP, CBM and wanfang(Date:each database construction to 2015.10) and applying REVMAN5.3 to analysis the data after RCTs are screened, evaluated quality and extracted data by two researchers separately.Results:1.66 systematic reviews has been retrieved in total, including 63 Chinese literature and 3 English literature and involving 39 different therapies. The result of the PRISMA scores showed that 64% of the SR had lower reporting quality and the result of the AMSTER scores showed that 88% of the SRs had lower methodological quality. Protocol and registration, publication status and the lists of inclusion and exclusion literature are the most easily overlooked methodological issues.Included report quality of RCTs are generally not high, the rate high quality RCTs is less than 1%.219 RCTS has been retrieved in total, including 2355patients,1200 in treatment group and 1155 in control group. Meta-analysis has shown that Traditional Chinese medicine can reduce the urine micro albumin in patients with DKD3 and 24 hours urinal protein and serum creatinine in patients with DKD4 and DKD5, improve the endogenous creatinine clearance rate(Ccr) and glomerular filtration rate(GFR), and regulate the lipid metabolism disorder in DKD patients. But the effect of glycosylated hemoglobin and blood pressure on DKD patients are not statistically significant compared with the control group.Conclusion:Applying PRISMA checklist and AMSTAR checklist to evaluate the epidemiology, quality and reporting characteristics of systematic reviews of RCTs on TCM in the treatment of DKD,it is found that they have low reporting and methodological quality, especially protocol and registration, publication status and the lists of inclusion and exclusion literature.These three items have a low reporting rate and the quality of original literature is low. These all affect the evidence intensity of findings. Therefore, systematic reviews in the future should be improved research quality by in accordance with the corresponding evaluation criteria to ensure the repeatability of the results of studies.2. Traditional Chinese medicine has good efficiency and safety in the treatment of DKD. Due to the included original literature has heterogeneity and methodological deficiencies, the results of this research need to be confirmed by carrying out large sample, multicenter, double-blind, randomized controlled clinical trails. |
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