Alprostadil for hypertensive nephropathy: A systematic review and meta-analysis of randomized controlled trials

Abstract

We performed a meta-analysis to evaluate the efficacy of alprostadil in the treatment of hypertensive nephropathy. Seven online databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI] database, Wanfang Data Knowledge Service Platform, VIP Information Resource Integration Service Platform [cqVIP], and China Biology Medicine Disc [SinoMed]) were searched from inception to January 31, 2022, and a set of clinical indicators for hypertensive nephropathy was selected. The main indicators were 24-h urinary protein, serum creatinine, endogenous serum creatinine clearance rate, blood urea nitrogen, cystatin C, and mean arterial pressure. The methodological quality of the included trials was analyzed using a risk of bias assessment according to the Cochrane Manual guidelines, and a meta-analysis was performed. A random-effects model was implemented to pool the results. A total of 20 randomized controlled trials involving 1441 patients with hypertensive nephropathy were included in this review. Our findings showed that alprostadil had a positive effect on 24-h urinary protein (mean difference [MD] = −0.79, 95% confidence interval [CI] [−1.16, −0.42], P < 0.0001), serum creatinine (MD = −13.83, 95% CI [−19.34, −8.32], P < 0.00001), endogenous serum creatinine clearance rate (MD = 6.09, 95% CI [3.59, 8.59], P < 0.00001), blood urea nitrogen (MD = −6.42, 95% CI [−8.63, −4.21], P < 0.00001), cystatin C (MD = −0.26, 95% CI [−0.34, −0.18], P < 0.00001), and mean arterial pressure levels(MD = −13.65, 95% CI [−16.08, −11.21], P < 0.00001). Compared to conventional treatment alone, alprostadil combined with conventional treatment can improve renal function in patients with hypertensive nephropathy more effectively. However, additional large-scale, multicenter, rigorously designed randomized controlled trials are needed to verify these results. This is the first meta-analysis to evaluate the efficacy of alprostadil for hypertensive nephropathy, and the results may guide clinical practice.

Contrast-Induced Acute Kidney Injury: Assessing The Effects of Pharmacological Preventive Measures

“…Therefore, it is commonly used to treat limb ulcers caused by chronic arterial occlusion, limb pain at rest caused by impaired microvascular circulation, cardiovascular and cerebrovascular microcirculation disorders, and as anticoagulation therapy after organ transplantation. Many clinicians utilize alprostadil in the treatment of hypertensive nephropathy [18].…”