Protective effect of Astragalus polysaccharide on diabetic nephropathy: A systematic review and meta‑analysis reveals the efficacy and potential mechanisms

Astragali radix is widely used to treat diabetes and Astragalus polysaccharides (APS) is a primary bioactive compound. Previous evidence has demonstrated that APS, when administered, is an effective monomer in the treatment of diabetic nephropathy (DN). In the present systematic review and meta‑analysis, the effects and potential underlying mechanisms of APS in the treatment of DN were evaluated. PubMed, Embase, EBSCO, Web of Science and OVID databases were employed to obtain the published studies included in the present meta‑analysis up to April 2024. Each article's quality was assessed using the Jadad score assessment scale. The odds ratios of risk factors were pooled using a random‑effects meta‑analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I‑Square (I²) tests, and publication bias was detected using the funnel plot and/or Egger's test. If necessary, the authors of the identified papers were contacted for more information. The primary outcomes were analyzed, including the parameters of creatinine, kidney‑to‑urine protein, blood urea nitrogen, urine protein and fasting blood glucose. Additionally, APS was found to reduce known risk factors, including kidney weight and total cholesterol levels. Furthermore, it was revealed that the therapeutic effects of APS in DN may be associated with antifibrotic, anti‑inflammatory and anti‑oxidative stress processes. The findings of the present study have validated the anti‑DN effects of APS, and the safety of its use; however, further rigorously designed and well‑performed preclinical trials are required in order to fully evaluate the anti‑DN effects and safety of APS, and to verify these findings prior to its possible clinical application.