Cardenas

Some laboratory evidence that hyperbaric oxygen improves renal function in diabetic renal disease.

Clinical bottom line:

1. Over four weeks of treatment, the HBO group showed improvements in renal disease parameters.
2. HBO patients were more likely to have improved kidney function and none deteriorated,

Citation/s: 1. Cardenas Ureña KG, Ramírez Nava JC, Márquez Celedonio FG, Salas Nolasco OI, Villegas Domínguez JE, and Celia Nohemí Crespo-Cortés. Clinical efficacy of adjuvant therapy with hyperbaric oxygen in diabetic nephropathy. Undersea & Hyperbaric Medicine 2020, 47(3): 415-422.
Author's contact: Karime Guadalupe Cárdenas Ureña – axo603@hotmail.com

Three-part Clinical Question:For patients with diabetic kidney disease, does the addition of hyperbaric oxygenation to standard therapy result in any improved renal function?
Search Terms: Diabetes, kidney disease, renal function

The Study:Double-blinded concealed randomised controlled trial without intention-to-treat.
The Study Patients: Diabeteic patients with diagnosed diabetic kidney disease of Stage 3 or worse
Control group (N = 9 ; 7 analysed): All normal care plus 20 daily sessions, Monday to Friday, breathing air at 1 ATA for 60 minutes in a hyperbaric chamber (sham)..
Experimental group (N = 8 ; 8 analysed): As above plus daily periods breathing 100% oxygen for 60 minutes at 2.5 ATA.

The Evidence:

Outcome

Time to Outcome

Control group rate

HBOT group rate

Relative risk increase

Absolute risk increase

NNT

Deteriorated in staging

4 weeks

0.56

0

100%

0.56

2

95% CIs:

 

0.23 to 0.88

1 to 4

 

Measure

Control Group

HBOT Group

Difference

95% CI

Mean

SD

Mean

SD

Urinary albumin/creatinine ratio (mg/g)

2861

2424

876

504

-1985

-3.19m to 3.18m

Estimated glomerular filtration rate (eGFR) (ml/min/1.73m2)

22.2

6.8

34.3

6.9

12.1

-40.4 to 64.6

HbA1c (%)

7.0

0.7

7.1

1.1

-0.1

-1.2 to 0.1

Comments:

1. Stage 3 chronic kidney disease is a reduction in renal function of about 50%.
2. No sample size calculation and two patients lost due to not completing treatment were not analysed.
3. Very small study with lower power to find important clinical differnces between groups.
4. The normal UACR is <30 mg/g and eGFR is >60 ml/min/1.73m2.
5. Four patients in the HBO group improved in staging of disease compred to none in the control group.

Appraised by:Mike Bennett m.bennett@unsw.edu.au; Saturday, 11 September 2021
Kill or Update By: September 2025

 

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