Are acupuncture and related therapies effective in symptom control for chronic kidney disease patients?
Date of publication of the systematic review: June 2016
Design
Systematic review of 24 randomized control trials (RCTs).
Participants
1787 adults aged 18 and above with chronic kidney disease (CKD) stage 3 to 5 or on dialysis, as defined by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, are included. Kidney transplant recipients or patients with acute kidney injury were excluded. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Among included RCTs, various forms of acupuncture and related therapies including manual acupuncture and acupressure, ear acupressure, transcutaneous electrical acupuncture point stimulation, far-infrared radiation on acupuncture points and indirect moxibustion were used as intervention. Treatment lengths varied from 10 days to 24 weeks. In most studies, the total number of treatment sessions varied between 8 and 36.
Comparator
Comparison: Acupuncture and related therapies versus routine care.
Major Outcomes
Outcome 1: Changes in depression score as measured by the Beck Depression Inventory after 4 weeks of treatment;
Outcome 2: Changes in fatigue score as measured by Piper Fatigue Scale after 4 weeks of treatment;
Outcome 3: Changes in sleep quality as measured by Pittsburgh Sleep Quality Index after 4 weeks of treatment.
Settings
The reviewers included trials conducting in inpatient or outpatient setting and some trials did not report where they were conducted.
Comparison    Acupuncture and related therapies versus routine care
Main Results
Compared with routine care, manual acupressure significantly reduced depression symptoms on the Beck Depression Inventory (pooled mean difference (pooled MD): -4.29, 95% CI: -7.48 to -1.11) after 4 weeks of treatment. It significantly reduced fatigue on the revised Piper Fatigue Scale (pooled MD: -1.19, 95% CI: -1.77 to -0.60) and showed a significant improvement on sleep quality measured by Pittsburgh Sleep Quality Index (pooled MD: -2.46, 95% CI: -4.23 to -0.69).
Comparison: Acupuncture and related therapies versus routine care among CKD patients
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) Pooled MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 3 (128) Not reported Not reported 0% -4.29 (-7.48 to -1.11) Moderate
2 (NA) 3 (128) Not reported Not reported 0% -1.19 (-1.77 to -0.60) Moderate
3 (NA) 4 (180) Not reported Not reported 50% -2.46 (-4.23 to -0.69) Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Acupuncture and related therapies versus routine care
Main Results
Compared with routine care, manual acupressure significantly reduced depression symptoms on the Beck Depression Inventory (pooled mean difference (pooled MD): -4.29, 95% CI: -7.48 to -1.11) after 4 weeks of treatment. It significantly reduced fatigue on the revised Piper Fatigue Scale (pooled MD: -1.19, 95% CI: -1.77 to -0.60) and showed a significant improvement on sleep quality measured by Pittsburgh Sleep Quality Index (pooled MD: -2.46, 95% CI: -4.23 to -0.69).
Comparison: Acupuncture and related therapies versus routine care among CKD patients
Outcomes (units) 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total no. of participants) 3 (128) 3 (128) 4 (180)
Mean score (SD)/ No. of participants Intervention Not reported Not reported Not reported
Comparator Not reported Not reported Not reported
Pooled MD (95% CI) -4.29 (-7.48 to -1.11) -1.19 (-1.77 to -0.60) -2.46 (-4.23 to -0.69)
Overall quality of evidence* Moderate Moderate Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Conclusion
Benefits
This study showed short-term effects of manual acupressure on improving depression, fatigue and sleep quality. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
The safety of acupuncture and related therapies could not be assessed due to incomplete reporting of serious adverse events.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27349639
The synopsis is based on the following article:
Kim KH, Lee MS, Kim TH, Kang JW, Choi TY, Lee JD. Acupuncture and related interventions for symptoms of chronic kidney disease. Cochrane Database Syst Rev. 2016 Jun 28;(6):CD009440.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.