Advanced Search

Journal of Traditional Chinese Medicine >

2024 , Vol. 44 >Issue 1: 182 - 187

DOI: https://doi.org/10.19852/j.cnki.jtcm.20231121.001

Original articles

Combination of allopurinol with Dahuang Mudan Tang (大黄牡丹汤) significantly improve kidney function and alleviate oxidative stress and inflammation of chronic kidney disease stage Ⅰ-Ⅲ patients with hyperuricemia

  • Congcong FANG ,
  • Xiaoliang ZHU ,
  • Yongjian ZHANG ,
  • Huan QI ,
  • Yingjie ZHANG
Expand
  • 1 Department of Endocrinology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China; Department of Nephrology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
    2 Department of Endocrinology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
    3 Department of Nephrology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China

Received date: 2023-01-12

  Accepted date: 2023-05-06

  Online published: 2023-11-21

Supported by

Qinhuangdao Science and Technology Research and Development Plan: Clinical Study of Rhubarb and Peony Decoction in the Treatment of Chronic Kidney Disease Stage 1-3 Complicated with Hyperuricemia(202101A203)

Fold

Abstract

OBJECTIVE: To evaluate the effect of Dahuang Mudan Tang (大黄牡丹汤, DHMD) and allopurinol on the treatment of chronic kidney disease staged G1-G3b patients with hyperuricemia and to provide novel insights into the clinical management of chronic kidney disease complications.

METHODS: A total of 80 chronic kidney patients staged G1-G3b with hyperuricemia were randomly grouped to receive single allopurinol treatment (control) and combined treatment with DHMD (treated) for 8 weeks. The kidney function and proteinuria indicators of patients were compared between pre-and post-treatment. The oxidative stress and inflammation responses were evaluated by corresponding indicators and cytokines. The clinical efficiency rate and adverse reaction events were also summarized to assess the therapeutic efficiency and safety.

RESULTS: The kidney function and proteinuria of enrolled patients were alleviated after their therapies, behaved as the increasing estimated glomerular filtration rate and decreasing serum creatinine, serum uric acid, urea nitrogen, 24 h urine protein levels. On the other hand, the malondialdehyde level and pro-inflammation cytokines were suppressed by the therapies, and the superoxide dismutase was found to be significantly enhanced. Patients in the treated groups showed a better recovery in kidney function, proteinuria, oxidative stress, and inflammation response. Moreover, patients in the treated group showed a higher efficiency rate (95%) and fewer adverse reaction events (5%).

CONCLUSIONS: The combination of allopurinol with DHMD significantly promoted the recovery of chronic kidney disease stage G1-G3b patients with hyperuricemia, which can be considered a novel clinical therapeutic strategy.

Key words： allopurinol; renal insufficiency, chronic; hyperuricemia; uric acid; urine protein; Rhubarb Peony decoction

Cite this article

Congcong FANG , Xiaoliang ZHU , Yongjian ZHANG , Huan QI , Yingjie ZHANG . Combination of allopurinol with Dahuang Mudan Tang (大黄牡丹汤) significantly improve kidney function and alleviate oxidative stress and inflammation of chronic kidney disease stage Ⅰ-Ⅲ patients with hyperuricemia[J]. Journal of Traditional Chinese Medicine, 2024 , 44(1) : 182 -187 . DOI: 10.19852/j.cnki.jtcm.20231121.001

References

1. Gaita L, Timar R, Lupascu N, et al. The impact of hyperuricemia on cardiometabolic risk factors in patients with diabetes mellitus: a cross-sectional study. Diabetes Metab Syndr Obes 2019; 12: 2003-10.
2. Waheed Y, Yang F, Sun D. Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease. Korean J Intern Med 2021; 36: 1281-93.
3. Sellmayr M, Hernandez Petzsche MR, Ma Q, et al. Only hyperuricemia with crystalluria, but not asymptomatic hyperuricemia, drives progression of chronic kidney disease. J Am Soc Nephrol 2020; 31: 2773-92.
4. Ejaz AA, Johnson RJ, Shimada M, et al. The role of uric acid in acute kidney injury. Nephron 2019; 142: 275-83.
5. Badve SV, Brown F, Hawley CM, et al. Challenges of conducting a trial of uric-acid-lowering therapy in CKD. Nat Rev Nephrol 2011; 7: 295-300.
6. Xu L, Lu LL, Gao JD. Traditional Chinese herbal medicine plays a role in the liver, kidney, and intestine to ameliorate hyperuricemia according to experimental studies. Evid Based Complement Alternat Med 2021; 2021: 4618352.
7. Zhang YX, Li JS, Peng WW, et al. Comparative pharmacokinetics of aloe-emodin, rhein and emodin determined by liquid chromatography-mass spectrometry after oral administration of a rhubarb peony decoction and rhubarb extract to rats. Pharmazie 2013; 68: 333-9.
8. Luo S, Wen R, Wang Q, et al. Rhubarb Peony decoction ameliorates ulcerative colitis in mice by regulating gut microbiota to restoring Th17/Treg balance. J Ethnopharmacol 2019; 231: 39-49.
9. Barthel W, Huller G, Haustein KO. Bioequivalence of allopurinol-containing tablet preparations. Int J Clin Pharmacol Ther 1999; 37: 148-52.
10. Stamp LK, Chapman PT, Palmer SC. Allopurinol and kidney function: an update. Joint Bone Spine 2016; 83: 19-24.
11. Levey AS, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 2011; 80: 17-28.
12. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 2014; 63: 713-35.
13. Liu FB. Application and prospect of scale measurement and appraisal in the assessment in TCM therapeutic efficacy evaluation. Zhong Guo Zhong Xi Yi Jie He Za Zhi 2007; 27: 1129-32.
14. Alderman M, Aiyer KJ. Uric acid: role in cardiovascular disease and effects of losartan. Curr Med Res Opin 2004; 20: 369-79.
15. Gupta MK, Singh JA. Cardiovascular disease in gout and the protective effect of treatments including urate-lowering therapy. Drugs 2019; 79: 531-41.
16. Viazzi F, Leoncini G, Ratto E, Pontremoli R. Hyperuricemia and renal risk. High Blood Press Cardiovasc Prev 2014; 21: 189-94.
17. Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and chronic kidney disease: an enigma yet to be solved. Ren Fail 2014; 36: 1351-9.
18. McDonagh EM, Thorn CF, Callaghan JT, Altman RB, Klein TE. PharmGKB summary: uric acid-lowering drugs pathway, pharmacodynamics. Pharmacogenet Genomics 2014; 24: 464-76.
19. Thurston MM, Phillips BB, Bourg CA. Safety and efficacy of allopurinol in chronic kidney disease. Ann Pharmacother 2013; 47: 1507-16.
20. Wang J, Zhao Y, Xiao X, et al. Assessment of the renal protection and hepatotoxicity of rhubarb extract in rats. J Ethnopharmacol 2009; 124: 18-25.
21. Iizuka A, Iijima OT, Kondo K, et al. Evaluation of Rhubarb using antioxidative activity as an index of pharmacological usefulness. J Ethnopharmacol 2004; 91: 89-94.
22. Deng Y, Liu F, Yang X, Xia Y. The key role of uric acid in oxidative stress, inflammation, fibrosis, apoptosis, and immunity in the pathogenesis of atrial fibrillation. Front Cardiovasc Med 2021; 8: 641136.
23. Milanesi S, Verzola D, Cappadona F, et al. Uric acid and angiotensin Ⅱ additively promote inflammation and oxidative stress in human proximal tubule cells by activation of toll-like receptor 4. J Cell Physiol 2019; 234: 10868-76.
24. Castro VMF, Melo AC, Belo VS, Chaves VE. Effect of allopurinol and uric acid normalization on serum lipids hyperuricemic subjects: a systematic review with Meta-analysis. Clin Biochem 2017; 50: 1289-97.
25. Settle T, Carro MD, Falkenstein E, Radke W, Klandorf H. The effects of allopurinol, uric acid, and inosine administration on xanthine oxidoreductase activity and uric acid concentrations in broilers. Poult Sci 2012; 91: 2895-903.
26. Perrenoud L, Kruse NT, Andrews E, et al. Uric acid lowering and biomarkers of kidney damage in CKD stage 3: a post hoc analysis of a randomized clinical trial. Kidney Med 2020; 2: 155-61.
27. Wang M, Lin X, Yang X, Yang Y. Research progress on related mechanisms of uric acid activating NLRP3 inflammasome in chronic kidney disease. Ren Fail 2022; 44: 615-24.
28. Wu TH, Li KJ, Yu CL, Tsai CY. Tamm-Horsfall protein is a potent immunomodulatory molecule and a disease biomarker in the urinary system. Molecules 2018; 23: 200.
29. Xiong C, Deng J, Wang X, et al. Pharmacologic targeting of BET proteins attenuates hyperuricemic nephropathy in rats. Front Pharmacol 2021; 12: 636154.
30. Xu ZG, Chen XQ, Zhang YJ, et al. Rhubarb peony decoction downregulates the expression of c-Fos after intestinal epithelial cells hypoxia-reoxygenation injury. Comb Chem High Throughput Screen 2022; 26: 498-506.
Options
Outlines

/

〈 〉