Shenkang injection for the treatment of acute kidney injury: a systematic review and meta-analysis

Figures & data

Table 1. Characteristics of the included studies.

Study	Sample size (T/C)	Sex(M/F)		Age(years)		Intervention		Course of treatment (d)	Outcomes	Adverse events
		T	C	T	C	T	C
Nie 2014 [16]	21/21	13/8	14/7	69.94 ± 5.36	68.61 ± 5.19	SKI (60-100ml qd ivgtt) + control	Symptomatic rehydration therapy + mechanical ventilation	7	SCr, CysC, APACHE IIscore	Not occurred
Song 2014 [17]	20/20	14/6	13/7	64.52 ± 7.36	67.24 ± 4.25	SKI (100 ml qd ivgtt) + control	Symptomatic rehydration therapy + hemodialysis (if necessary)	7	SCr, APACHE II score, MODS score	Not mentioned
Shi 2016 [18]	33/33	17/16	18/15	58.9 ± 4.5	58.6 ± 3.9	SKI (60-100ml qd ivgtt) + control	Symptomatic rehydration therapy + ventilator therapy (if necessary)	7	SCr, BUN, CysC, 24h-Upro, β2-MG, APACHE II,24h-UV	T: 2 epigastric discomfort; 2 nausea and vomiting C: 1 epigastric discomfort; 2 nausea and vomiting
Jia 2017 [19]	38/38	21/17	22/16	27 people ≤ 40 and 11 people > 40	29 people ≤ 40 and 9 people > 40	SKI (100 ml qd ivgtt) + CDC 1# tid po + control	CDC 1# tid po + Symptomatic rehydration therapy + hormones + Immunosuppressants (if necessary)	14	SCr, Alb, BUN, 24h-Upro, NAG, KIM-1,D, Vmax, RI, PT, APTT, TT,FIB, PAI-1, t-PA, vWF, D-D	Not mentioned
Liu 2017 [20]	40/40	24/16	25/15	45.3 ± 3.8	44.9 ± 4.6	SKI (80 ml qd ivgtt) + Simvastatin (20 mg qn po) + control	Simvastatin (20 mg qn po) + Symptomatic rehydration therapy + hemodialysis (if necessary)	21	SCr, BUN, SOD, MDA	Not mentioned
Wang 2017 [21]	30/30	18/12	16/14	72.3 ± 3.2	71.5 ± 3.4	SKI (60-100ml qd ivgtt) + control	Symptomatic rehydration therapy + ventilator therapy (if necessary)	7	SCr, CysC, NGAL, hs-CRP, IL-6, APACHE-IIscore, SOFA score	Not occurred
Gao 2020 [22]	49/49	28/21	27/22	68.23 ± 4.93	67.83 ± 5.02	SKI (40-60ml qd ivgtt) + control	Symptomatic rehydration therapy + hemodialysis (if necessary)	7	SCr, CysC, APACHE IIscore	Not occurred
Li 2020 [23]	25/25	16/9	18/7	31.95 ± 5.07	32.68 ± 5.21	SKI (100 ml qd ivgtt) + control	Symptomatic rehydration therapy	28	SCr, Cys C, β2-MG, 24H-UV	Not mentioned
Wang 2020 [24]	45/45	22/23	25/20	45.8 ± 2.9	45.1 ± 2.2	SKI (100 ml qd ivgtt) + CDC 1# tid po + control	CDC 1# tid po + Symptomatic rehydration therapy + hormones + immunosuppressant	14	SCr, Alb, BUN, 24h-Upro, NAG, KIM-1	Not mentioned
Zhang 2020 [25]	48/48	34/14	31/17	56.94 ± 6.08	56.75 ± 6.23	SKI (100 ml qd ivgtt) + control	Symptomatic rehydration therapy + hemodialysis	7	24h-Upro, SCr, BUN, GFR, KIM-1, NGAL, IL-6, IL-8	Not mentioned
Chen 2021 [26]	67/67	27/40	29/38	41.46 ± 5.18	41.15 ± 4.27	SKI (100 ml qd ivgtt) + CDC 0.5 g tid po + control	CDC 0.5 g tid po + Symptomatic rehydration therapy	14	SCr, Alb, BUN, PT, APTT, TT, FIB, IL-6, TNF-α, CRP	T: 3 infected; 4 nausea and vomiting; 2 Gastrointestinal Bleeding; 2 Retention of water and sodium C: 2 infected; 3 nausea and vomiting; 1 Gastrointestinal Bleeding; 2 Retention of water and sodium

(T, treatment group; C, control group; SCr, serum creatinine; BUN, blood urea nitrogen; CysC, cystatin c; APACHE IIscore, Acute Physiology and Chronic Health Evaluation IIscore; 24h-Upro, 24-Hour Urine Protein; β2-GM, β2-microglobulin; 24h-UV, 24 h urine volume; MODS score, multiple organ dysfunction syndrome score; Alb, albumin; NAG, N-acetyl-β-D-glucosidase; KIM-1, kidney injury molecule 1; D, diameter of renal artery; RI, renal resistive index; V_max, the maximum systolic blood flow velocity of renal artery; PT, prothrombin time; TT, thrombin time; FIB, fibrinogen; APTT, activated partial thromboplastin time; PAI-1, plasminogen activator inhibitor-1; t-PA, tissue plasminogen activator; vWF, von Willebrand Factor; D-D, d-dimer assay; SOD, superoxide dismutase; MDA, malondialdehyde; NGAL, neutrophil gelatinase-associated lipocalin; IL-6. Interleukin-6; IL-8, interleukin-8; TNF-α, tumor necrosis factor-α; CRP, c reactive proteins; hs-CRP, hypersensitive c reactive proteins; SOFA score, sepsis-related organ failure assessment score; GFR, glomerular filtration rate; CDC, Calcium Dobesilate Capsules).

Figure 1. Risk bias of graph.

Figure 2. Risk bias of summary.

Figure 3. PRISMA flow diagram.

SCr

Table 2. Quality assessment.

Quality assessment							No of patients		Effect		Quality	Importance
No of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	T	C	Relative (95% CI)	Absolute
Serum Creatinine
11	randomized trials	Serious^a	Serious^b	no serious indirectness	no serious imprecision	None^c	409	398		MD 23.31 lower (28.06 to 18.57 lower)	⊕⊕○○↓ LOW	Critical
Blood Urea Nitrogen
6	randomized trials	Serious^a	Serious^b	no serious indirectness	no serious imprecision	none	271	271		MD 2.07 lower (2.56 to 1.57 lower)	⊕⊕○○↓ LOW	Critical
Cystatin C
5	randomized trials	Serious^a	Serious^b	no serious indirectness	no serious imprecision	none	155	149		MD 0.55 lower (0.78 to 0.32 lower)	⊕⊕○○↓ LOW	Critical
24-Hour Urine Protein
4	randomized trials	Serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	none	164	164		MD 0.43 lower (0.53 to 0.34 lower)	⊕⊕⊕○↓ MODERATE	Critical
APACHE II Score
5	randomized trials	Serious^a	Serious^b	no serious indirectness	no serious imprecision	none	146	135		MD 3.07 lower (3.67 to 2.48 lower)	⊕⊕○○↓ LOW	Critical
Adverse Reactions
5	randomized trials	Serious^a	no serious inconsistency	no serious indirectness	no serious imprecision	Reporting bias [3]	15/185 (8.1%)	11/189 (5.8%)	RR 1.32 (0.66 to 2.63)	19 more per 1000 (from 20 fewer to 95 more)	⊕⊕○○↓ LOW	Important

^aSome of the included studies did not describe how the blinding and allocation of concealment was implemented.

^b Although the source of heterogeneity cannot be explained, the results are robust.

^cEgger's test indicates publication bias.

Figure 4. Forrest plot of SCr.

Figure 5. Funnel plot of SCr.

Subgroup of Scr

Figure 6. Subgroup by age of SCr.

Figure 7. Subgroup by treatment of SCr.

Figure 8. Subgroup by hemodialysis of SCr.

Figure 9. Subgroup by immunosuppressant of SCr.

BUN

Figure 10. Forrest plot of BUN.

Figure 11. Funnel plot of BUN.

CysC

Figure 12. Forrest plot of CysC.

Figure 13. Funnel plot of CysC.

24h-Upro

Figure 14. Forrest plot of 24-hour urine protein.

Figure 15. Funnel plot of 24-hour urine protein.

APACHE II SCORE

Figure 16. Forrest plot of APACHE II SCORE.

Figure 17. Funnel plot of APACHE II SCORE.

Adverse Reactions

Figure 18. Forrest plot of adverse reactions.

Figure 19. Funnel plot of adverse reactions.

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Data availability statement

The study contains original contributions that are included in the article/supplementary material. For additional information, please contact the corresponding author.