Combination therapy with Chinese medicine and ACEI/ARB for the management of diabetic nephropathy: the promise in research fragments.

Background: The clinical benefits of the application of renin-angiotensin system (RAS) blockade, i.e., angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), have been well established in patients with diabetic nephropathies (DN). Since the combination therapy with Chinese Medicine (CM) and conventional western medicine (CWM) is considered an effective approach to many conditions, many CM experts have investigated the combination therapy with CM and RAS blockade to look for new approaches to DN. Aim: The purpose of this article is to review the antiproteinuric and renopretective effects of combination therapy of CM and ACEI/ARBs for the management of DN. Methods: Relevant articles were identified through PubMed and three major Chinese databases (CBM, CAJD, CSTJ) up to March 2013. Findings: The results of the current literature are consistent with CM theories (e.g., tonifying and replenishing CM with blood-activating and stasis-resolving CM as major therapeutic strategies for the management of DN). 91 clinical articles on the combination therapy of CM and ACEI/ARBs were identified, but only eight randomized controlled trials were eventually included in the present review. The results were not always consistent: three articles reported that CM conferred both anti-proteinuric and reno-protective effects in addition to ACEI/ARBs; three articles reported that CM failed to provide additional reno-protective benefits; two articles reported that CM conferred neither anti-proteinuric nor reno-protective effects in addition to ACEI/ARBs. Conclusion: Current literature indicates that combination therapy with CM and ACEI/ARBs might have polypharmacological anti-proteinuric and reno-protective effects for the management of DN. Shortcomings concerning the interaction between CM and CWM, methodology, and study design need to be addressed in future research.