The Effect of Pentoxifylline on Proteinuria in Diabetic Kidney Disease: A Meta-analysis

McCormick, Brendan B.; Sydor, Amy; Akbari, Ayub; Fergusson, Dean; Doucette, Steve; Knoll, Greg

doi:10.1053/j.ajkd.2008.01.025

« Previous Next »American Journal of Kidney Diseases
Volume 52, Issue 3 , Pages 454-463, September 2008

The Effect of Pentoxifylline on Proteinuria in Diabetic Kidney Disease: A Meta-analysis

Brendan B. McCormick, MD
- Division of Nephrology, Kidney Research Center, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Address correspondence to Brendan B. McCormick, MD, Division of Nephrology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Dr, Ottawa, Ontario, Canada K1H 7W9
Amy Sydor, MD
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Ayub Akbari, MD
- Division of Nephrology, Kidney Research Center, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Dean Fergusson, PhD
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
Steve Doucette, MSc
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
Greg Knoll, MD, MSc
- Division of Nephrology, Kidney Research Center, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

Received 7 September 2007; accepted 2 January 2008. published online 23 April 2008.

Background

Pentoxifylline is a potential therapeutic agent for diabetic kidney disease because it has anti-inflammatory, antifibrotic, and hemorheological properties.

Study Design

Systematic review and meta-analysis of randomized controlled trials.

Setting, Population, & Intervention

Adult patients with diabetic kidney disease who received oral pentoxifylline.

Selection Criteria for Studies

We searched bibliographic databases for trials involving pentoxifylline that reported proteinuria, glomerular filtration rate, or blood pressure.

Outcomes

The primary outcome measure was the effect of pentoxifylline on proteinuria stratified by whether pentoxifylline was compared with renin-angiotensin system blockade.

Results

10 studies including a total of 476 participants with a median duration of 6 months were identified. Pentoxifylline significantly decreased proteinuria (weighted mean difference, −278 mg/d of protein; 95% confidence interval [CI], −398 to −159; P < 0.001) compared with placebo or usual care. Compared with captopril, the decrease in proteinuria with pentoxifylline was similar (weighted mean difference, 0 mg/d of protein; 95% CI, −17 to 18; P = 0.9). Secondary analysis showed that patients with microalbuminuria had a nonsignificant decrease in protein excretion (weighted mean difference, −87 mg/d; 95% CI, −201 to 27; P = 0.1), whereas those with overt proteinuria (protein > 300 mg/d) had a significant decrease (weighted mean difference, −502 mg/d; 95% CI, −805 to −198; P = 0.001). No significant changes in systolic or diastolic blood pressure or glomerular filtration rate were found.

Limitations

Quality scores of studies were low, and there was significant heterogeneity.

Conclusions

Available evidence suggests that pentoxifylline may decrease proteinuria in patients with diabetic nephropathy. To confirm these findings, large high-quality studies are required.

Index Words: Pentoxifylline, trental, diabetes mellitus, diabetic nephropathy, proteinuria, albuminuria