title: Effect of pentoxifylline on renal outcomes in chronic kidney disease patients: A systematic review and meta-analysis.
abstract: Chronic kidney disease (CKD) represents an important health problem worldwide and the search for new therapeutic approaches for retarding CKD progression is a timely issue. Recent evidence suggest that the anti-inflammatory and hemorrheologic drug Pentoxifylline (PTX), may produce favorable effects on kidney function. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to ascertain whether PTX derivatives, alone or in combination to other treatments, may be useful in slowing down disease progression in patients with diabetic or non-diabetic CKD. We found 26 studies (1518 subjects) matching our search criteria. Information on the effects of PTX on hard renal outcomes (doubling of serum creatinine or need for chronic dialysis) were lacking in all the reviewed trials. Conversely, PTX was effective in reducing proteinuria compared to control, a benefit that was more evident in patients with type-1 diabetes mellitus, higher proteinuria at baseline and early renal impairment. An improvement in renal function (eGFR/creatinine clearance) was observed particularly in patients with more advanced CKD stage and in studies with longer follow-up. Conversely, cumulative analyses did not reveal any evident reduction in urinary albumin excretion, even in diabetic patients. The use of PTX was relatively safe as most trials recorded only minor gastrointestinal adverse effects. Although these findings point at some reno-protective effects of PTX, there is no conclusive evidence proving the usefulness of this agent for improving renal outcomes in subjects with chronic kidney disease of various etiology. Future trials adequately powered and designed on hard clinical end-points are needed.
authors.affiliation: Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, University ⿿Magna Graecia⿿ of Catanzaro, Catanzaro, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Leporini
authors.affiliation: CNR⿿Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pisano
authors.affiliation: Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, University ⿿Magna Graecia⿿ of Catanzaro, Catanzaro, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo
authors.affiliation: CNR⿿Institute of Clinical Physiology, Reggio Calabria, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: D Arrigo
authors.affiliation: Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Sciences, University ⿿Magna Graecia⿿ of Catanzaro, Catanzaro, Italy.
authors.forename: Giovambattista
authors.initials: G
authors.lastname: de Sarro
authors.affiliation: Nephrology and Dialysis Unit, ⿿Pugliese- Ciaccio⿿ Hospital of Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coppolino
authors.affiliation: CNR⿿Institute of Clinical Physiology, Reggio Calabria, Italy. Electronic address: davide.bolignano@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
mesh_terms: D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D010431:Pentoxifylline / Q000627:therapeutic use*; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine
chemical_list: D010431:Pentoxifylline
keywords: Albuminuria; Chronic kidney disease; Pentoxifylline; Proteinuria; Renal function; Side-effects