Astragalus Improves Glomerular Filtration Rate in Diabetic Patients with Chronic Kidney Disease

by | Jul 30, 2024 | 2024, Botanicals, Diabetes, Kidney Health, Recent Articles

Written by Chrystal Moulton, Science Writer. Evaluators found a significant difference in eGFR slope decline in patients treated with astragalus compared to those with standard care only (P = 0.003).

doctor and patient discussing kidney scanAstragalus membranaceus is an herb generally used in Chinese medicine that contains both anti-inflammatory, antifibrotic saponins, and antioxidative properties1,2. Chinese herbalists have successfully used astragalus in order to support individuals with reduced kidney function and kidney failure3,4. Chronic kidney disease is common among individuals with diabetes and significantly reduces quality of life while increasing mortality5. Since astragalus has anti-inflammatory and anti-fibrotic saponins, researchers in the current trial hypothesized that astragalus could be beneficial to individuals with chronic kidney disease. A preclinical trial demonstrated that a component of astragalus ameliorated kidney fibrosis in mice6. In the current trial, Researchers investigated the effectiveness of astragalus in stabilizing glomerular filtration rate [GFR] and urine albumin to creatinine ratio [UACR] in diabetic patients with chronic kidney disease7.

Patients were recruited from multiple centers of treatment. The study was designed as a randomized, parallel, single blinded study which used standard care as the control. Only the evaluator of the results was blinded. Patients aged 35 to 80 years old with persistent macroalbuminuria, stage 2-3 chronic kidney disease, who were living with type 2 diabetes for more than five years and had more than 12 weeks of stable antidiabetic regimens with ACEi (angiotensin converting enzyme inhibitor) / ARB (angiotensin receptor blocker) were included in this trial. Eligible participants were randomly assigned to either add-on astragalus based treatment or continued standard care only. Patients assigned to the astragalus group were given 15 g/day of astragalus for 48 weeks in addition to standard care. The intervention was provided to the participants as granules taken twice daily after dissolving in boiling water. Individuals in the intervention group were given a 5-day supply of astragalus granules on a weekly basis. Patients in both groups had regular weekly visits during which time, researchers assessed the patient’s adherence to their assigned protocol. The primary outcome was a change in estimated glomerular filtration rate (eGRF) and urine albumin to creatinine ratio (UACR). Secondary outcomes included changes in biochemistry, biomarkers, blood pressure, and endpoint levels of glomerular filtration rate (GRF) and urine albumin to creatinine ratio (UACR). Evaluators measured these outcomes using blood and urine samples collected at week 6, week 24, and week 48.

A total of 175 patients with matching UACR, eGFR, and demographics were eligible for this trial. Of them, 118 patients were randomly assigned to receive additional astragalus with standard care (N = 56) or standard care only (N = 62). The average age of participants was 67.9 ±7.8 years old. Average eGFR was 58.0 ±17.5 ml/ min/1.73 m2 and the geometric average of UACR was 1105 ±19.5 mg/g. Ultimately, Results were gathered from 113 patients after randomization and 107 patients provided endpoint primary outcome measures as patients were lost during observation and follow up. Evaluators found a significant difference in eGFR slope decline in patients treated with astragalus compared to those with standard care only (P = 0.003). No significant difference was observed in slope change for UACR between the standard care and astragalus group. In secondary outcomes, researchers observed a significant increase in eGFR in the astragalus treated patients compared to those assigned standard of care (P = 0.003). No significant difference was observed for UACR between both groups. Systolic blood pressure was 7.9 mmHg lower in the astragalus treated patients compared to standard of care (P = 0.003). Further analysis showed that the change in systolic blood pressure was not associated with eGFR outcomes. Furthermore, percent change of eGFR was similar in both groups with and without antihypertensive medication. Three severe adverse events were recorded among three patients receiving the intervention that required discontinuation of astragalus. Eight severe adverse events were recorded among seven patients receiving standard care. In both groups severe adverse events included hyperkalemia, pancreatitis with acidosis and acute kidney injury, hospitalized dyspnea, ischemic stroke, lung infection with fluid overload, laryngeal obstruction, palpitation with dehydration, hypertension, spontaneous death, and injurious fall. A total of 117 adverse events were documented across both groups; of which, the most common were muscular skeletal pain, hyperkalemia, hypoglycemia, dizziness, and limb edema. Individuals in the intervention group reported most often dizziness and musculoskeletal pain.

Overall, the trial demonstrated that astragalus treatment as an add on to standard care could slow the decline of glomerular filtration rate and thus, slow decline of diseased kidneys in diabetic patients with chronic kidney disease. Additional research will be needed to verify these findings.

Source: Chan, Kam Wa, Alfred Siu Kei Kwong, Pun Nang Tsui, Gary Chi Wang Chan, Wing Fai Choi, Wai Han Yiu, Simon Chi Yuen Cheung et al. “Add-on astragalus in type 2 diabetes and chronic kidney disease: A multi-center, assessor-blind, randomized controlled trial.” Phytomedicine 130 (2024): 155457.

© 2024 Published by Elsevier GmbH.

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Posted July 30, 2024.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

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