The efficacy and safety of Ginkgo biloba L. leaves extract combined with ACEI/ARB on diabetic kidney disease: a systematic review and meta-analysis of 41 randomized controlled trials

• Published in: Frontiers in pharmacology 2025-01, Vol.15, p.1408546
• Main Authors: Zhang, Zehua, Tang, Shiyun, Liu, Shiyu, Leng, Yulin, Fu, Xiaoxu, Xie, Hongyan, Gao, Hong, Xie, Chunguang
• Format: Article
• Language: English
• Subjects: diabetic kidney disease; Ginkgo biloba L. leaves extract; meta-analysis; randomized controlled trials; systematic review
• ISSN: 1663-9812; 1663-9812
• DOI: 10.3389/fphar.2024.1408546

Diabetic kidney disease (DKD) has become the leading cause of end-stage renal disease in the world. However, the current conventional approaches have not yet achieved satisfactory efficacy. As one of the most influential products in botanical medicine, L. leaves extract (GBE) demonstrates various pharmacological effects on DKD and is gradually used as an adjunctive therapy for this disease. A comprehensive analysis is necessary to evaluate the efficacy and safety of GBE as an adjuvant treatment for DKD. This meta-analysis aimed to evaluate the efficacy and safety of GBE as a supplementary treatment to conventional renin-angiotensin-aldosterone system inhibitors for DKD patients, providing a reference for subsequent research and clinical practice. This study has been registered in PROSPERO as CRD42023455792. Ten databases were searched from their inception to 21 July 2023. Randomized controlled trials about GBE and DKD were included. Review Manager 5.4 and Stata 16.0 were employed to conduct the analysis. Heterogeneity was assessed through the χ test and the I test, and the effect model was chosen accordingly. Meta-regression and subgroup analysis were performed to investigate the sources of heterogeneity and the influence of different factor levels on efficacy. The publication bias was evaluated with the funnel plot and Egger's test, and the evidence quality was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. A total of 41 studies with 3,269 patients were finally enrolled in this study. None of the included studies reported whether renal or cardiovascular disease progression events occurred. Compared with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) alone, the combination with GBE was more beneficial in improving urinary albumin excretion rate (UAER) [mean difference (MD) = -22.99 μg/min, 95% confidence interval (CI): -27.66 to -18.31, < 0.01], serum creatinine (SCr) [MD = -8.30 μmol/L, 95% CI: -11.55 to -5.05, < 0.01], blood urea nitrogen (BUN) [MD = -0.77 mmol/L, 95% CI: -1.04 to -0.49, < 0.01], 24-hour urinary total protein (24hUTP) [MD = -0.28 g/d, 95% CI: -0.35 to -0.22, < 0.01], cystatin C (Cys-C) [MD = -0.30 mg/L, 95% CI: -0.43 to -0.17, < 0.01], total cholesterol (TC) [MD = -0.69 mmol/L, 95% CI: -1.01 to -0.38, < 0.01], triglyceride (TG) [MD = -0.40 mmol/L, 95% CI: -0.56 to -0.23, < 0.01], low-density lipoprotein cholesterol (LDL-C) [MD = -0.97 mmol/L, 95% CI