Add-on alprostadil may boost renal function in hypertensive nephropathy

Combining alprostadil with conventional treatment appears to lead to a more effective improvement in renal function among patients with hypertensive nephropathy, reports a recent meta-analysis.

Drawing from the online databases of PubMed, Embase, the Cochrane Library, CNKI, SinoMed, cqVIP, and Wanfang Data Knowledge Service Platform, researchers retrieved 20 randomized controlled trials eligible for quantitative synthesis. Studies looked at 24-hour urinary protein, serum creatinine, and endogenous serum creatinine clearance rate, among other parameters, as main indicators for hypertensive nephropathy.

The combined sample included 1,441 patients. Pooled analysis revealed that add-on alprostadil led to a significant reduction in 24-hour urinary protein levels (mean difference [MD], –0.79, 95 percent confidence interval [CI], –1.16 to –0.42; p<0.0001).

A similarly significant and beneficial reduction was reported for serum creatinine (MD, –13.83, 95 percent CI, –19.34 to –8.32; p<0.00001), blood urea nitrogen (MD, –6.24, 95 percent CI, –8.63 to –4.21; p<0.00001), cystatin C (MD, –0.26, 95 percent CI, –0.34 to –0.18; p<0.00001), and mean arterial pressure (MD, –13.65, 95 percent CI, –16.08 to –11.21; p<0.00001).

Meanwhile, pooled estimates also showed a significant improvement in the endogenous serum creatinine clearance rate following alprostadil intervention (MD, 6.09, 95 percent CI, 3.59–8.59; p<0.00001).

“This is the first meta-analysis to evaluate the efficacy of alprostadil for hypertensive nephropathy, and the results may guide clinical practice,” the researchers said. “However, additional large-scale, multicentre, rigorously designed randomized controlled trials are needed to verify these results.”