Effects and safety of Ophiocordyceps sinensis preparation in the adjuvant treatment for dialysis patients: a systematic review and meta-analysis.

2024-07-19
Frontiers in pharmacology 15
- Meixi Liu
- Chengji Cui
- Tianying Chang
- Qingshan Zhou
- Yingzi Cui
- Shoulin Zhang
- Xing Liao

PubMed: 39101133
DOI: 10.3389/fphar.2024.1360997

Study Design

Type: Systematic Review
Sample size: n = 914
Population: patients undergoing dialysis
Methods: systematic search through nine electronic databases up to 31 April 2024; Cochrane risk-of-bias tool; GRADE assessment; meta-analysis of 35 RCTs involving 2,914 patients

Ethnopharmacological relevance

Ophiocordyceps sinensis (O. sinensis), a genus of ascomycete fungi, has been widedly used in China as a dietary supplement or natural remedy and intensively studied in various disease models with its immunomodulatory potentials. It is a rich source of various bioactive compounds and used for treating end-stage renal disease. This systematic review with clinical evidence aimed to highlight the efficacy and safety of O. Sinensis as an adjuvant treatment for patients undergoing dialysis.

Materials and methods

A systematic search through nine electronic databases up to 31 April 2024, was conducted for related studies. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the certainty of evidence. Two researchers independently searched the literature and evaluated the risk of bias.

Results

After the screening, 35 randomized controlled trials (RCTs) involving 2,914 patients were eventually included. The meta-analysis showed that using O. sinensis effectively reduced the following outcomes in patients undergoing dialysis: C-reactive protein (15RCTs, MD = -2.22, 95% CI -3.24 to -1.20; very low certainty evidence); creatinine (22RCTs, MD =1.33, 95% CI -1.79 to -0.87; very low certainty evidence); blood urea nitrogen (21RCTs, MD = -1.57, 95% CI -2.07 to -1.07; low certainty evidence);. It could also effectively improve the following outcomes in patients undergoing dialysis: albumin (20RCTs, MD = -0.81, 95% CI -1.21 to -0.41; low certainty evidence); hemoglobin (19RCTs, MD = -1.00, 95% CI -1.43 to -0.57; low certainty evidence). The rate of adverse drug reactions was higher in the control group than in the experimental group (4RCTs, MD = 1.81, 95% CI 0.88-3.74).

Conclusion

The current evidence indicates that patients with dialysis receiving O. sinensis in the adjuvant treatment may improve nutritional and micro-inflammatory status and renal function for both hemodialysis and peritoneal dialysis patients. However, some limitation affected the generalizability of our findings. High-quality studies evaluating mortality outcomes of patients with different dialytic modalities in CKD are warranted in future.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324508, registration number CRD42022324508.

Research Insights

Cordyceps→Increased Hemoglobin Levels
hemoglobin (19RCTs, MD = -1.00, 95% CI -1.43 to -0.57; low certainty evidence)
Effect
Beneficial
Effect size
Small
Cordyceps→Increased Serum Albumin Levels
albumin (20RCTs, MD = -0.81, 95% CI -1.21 to -0.41; low certainty evidence)
Effect
Beneficial
Effect size
Small
Cordyceps→Reduced Blood Urea Nitrogen Levels
blood urea nitrogen (21RCTs, MD = -1.57, 95% CI -2.07 to -1.07; low certainty evidence)
Effect
Beneficial
Effect size
Small
Cordyceps→Reduced C-Reactive Protein Levels
C-reactive protein (15RCTs, MD = -2.22, 95% CI -3.24 to -1.20; very low certainty evidence)
Effect
Beneficial
Effect size
Small
Cordyceps→Reduced Creatinine Level
creatinine (22RCTs, MD =1.33, 95% CI -1.79 to -0.87; very low certainty evidence)
Effect
Beneficial
Effect size
Small

Adverse Events Reported

Cordyceps→Overall tolerability
The rate of adverse drug reactions was higher in the control group than in the experimental group (4RCTs, MD = 1.81, 95% CI 0.88-3.74).
Finding
Reported