Effects of acupuncture in patients with chronic kidney disease: a systematic review

Melo, Geórgia Alcântara Alencar; Aguiar, Letícia Lima; Silva, Renan Alves; Pereira, Francisco Gilberto Fernandes; Silva, Fabiana Larissa Barbosa da; Caetano, Joselany Áfio

doi:10.1590/0034-7167-2018-0784

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2018-0784 copy

Effects of acupuncture in patients with chronic kidney disease: a systematic review

Efectos de la acupuntura en pacientes con insuficiencia renal crónica: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the effects of acupuncture techniques in patients with chronic kidney disease.

Methods:

a systematic review conducted in six databases, from September to December 2017, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ criteria. The following descriptors were used: Acupuncture AND Chronic Renal Insufficiency AND Clinical Trial.

Results:

nine studies were selected; the acupuncture techniques used were auriculotherapy, electroacupuncture and acupressure aimed at improving quality of life, fatigue, sleep and clinical variables of the disease. The studies that assessed quality of life, sleep and fatigue presented significant benefits. Studies that assessed quality of life, sleep and fatigue presented significant benefits. There was no statistical significance in the improvement of serum creatinine levels and glomerular filtration rate. Methodological and assessment tools’ divergence made impossible meta-analysis

Conclusions:

studies reinforce the positive effect of acupuncture in improving quality of life, fatigue and sleep in patients.

Descriptors:
Acupuncture; Renal Insufficiency, Chronic; Review; Complementary Therapies; Nursing

Code, author, reference and year	Study objectives and research subjects (N)	Methodological Quality
(01) Wang et al.(¹⁴14 Wang S, Chen Z, Fu P, Zang L, Wang L, Zhai X, et al. Use of Auricular Acupressure to Improve the Quality of Life in Diabetic Patients with Chronic Kidney Diseases: a prospective randomized controlled trial. Evidence-Based Complement Altern Med [Internet]. 2014 [cited 2017 Sep 15];2014:1-11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276331/ https://www.ncbi.nlm.nih.gov/pmc/article... ), 2014	To assess the effectiveness of auricular acupuncture for improving the quality of life of diabetic patients with CKD.N=62	Double-blind, adequately selected and randomized in GE (auriculotherapy) and GC (routine care). It describes follow-up losses and presents necessary information on data collection and analysis.
(02) Yu et al.(¹⁵15 Yu JS, Ho CH, Wang HY, Chen YH, Hsieh CL. Acupuncture on renal function in patients with chronic kidney disease: a single-blinded, randomized, preliminary controlled study. J Altern Complement Med [Internet].2017 [cited 2017 Sep 15];23(8):624-631. Available from: http://online.liebertpub.com/doi/10.1089/acm.2016.0119 http://online.liebertpub.com/doi/10.1089... ), 2017	To verify the viability effect of acupuncture on kidney function in patients with CKD.N=59	Blind, adequately selected and randomized DR GE (systemic acupuncture) and GC (needles inserted outside the acupuncture point). It describes follow-up losses and presents necessary information on data collection and analysis.
(03) Hadadian et al.(¹⁶16 Hadadian F, Sohrabi N, Farokhpayam M, Farokhpayam H, Towhidi F, Fayazi S, et al. The effects of transcutaneous electrical acupoint stimulation (TEAS) on fatigue in haemodialysis patients. J Clin Diagn Res [Internet]. 2016 [cited 2017 Sep 15];10(9):YC01-YC04. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072066/ https://www.ncbi.nlm.nih.gov/pmc/article... ), 2016	To analyze the effects of Transcutaneous Electrical Acupoint Stimulation (TEAS) on CKD fatigue.N=56	Blind. It does not describe selection and randomization technique. Patients were divided into GE (TEAS) and GC (TEAS off the acupuncture point). It describes follow-up losses and presents necessary information on data collection and analysis.
(04) Shen et al.(¹⁷17 Shen K, Cho Y, Pascoe EM, Hawley CM, Oliver V, Hughes KM, et al. The siestatrial: a randomized study investigating the efficacy, safety, and tolerability of acupressure versus sham therapy for improving sleep quality in patients with end-stage kidney disease on hemodialysis. Evidence-Based Complement Altern Med [Internet]. 2017 [cited 2017 Sep 15];2017:1-10. Available from: https://www.hindawi.com/journals/ecam/2017/7570352/ https://www.hindawi.com/journals/ecam/20... ), 2017	To investigate the effect of acupuncture on the sleep quality of patients underdialysis.N=42	Double-blind, adequately selected and randomized in GE (systemic acupuncture) and GC (needles inserted outside the acupuncture point). It describes follow-up losses and presents necessary information on data collection and analysis.
(05) Zou et al.(¹⁸18 Zou C, Yang L, Wu Y, Su G, Chen S, Guo X, et al. Auricular acupressure on specific points for hemodialysis patients with insomnia: a pilot randomized controlled trial. PLoS One [Internet]. 2015 [cited 2017 Sep 17];10(4):e0122724. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25874938 https://www.ncbi.nlm.nih.gov/pubmed/2587... ), 2015	To assess the effects of auriculotherapy in patients with insomnia.N=63	Double-blind, adequately selected and randomized in GE (auriculotherapy), GC (routine care). It describes follow-up losses and presents necessary information on data collection and analysis.
(06) Sabouhi et al.(¹⁹19 Sabouhi F, Kalani L, Valiani M, Mortazavi M, Bemanian M. Effect of acupressure on fatigue in patients on hemodialysis. Iran J Nurs Midwifery Res [Internet]. 2013 [cited 2017 Sep 3];18(6):429-34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24554938 http://www.ncbi.nlm.nih.gov/pubmed/24554... ), 2013	To ascertain the effect of acupressure on the fatigue of patients with CKD.N=96	Patients appropriately selected. It does not describe technique of randomization and blinding. Patients were divided into GE (acupressure), Placebo (acupressure outside the acupuncture point) and GC (routine care). It does not describe follow-up losses and presents necessary information on data collection and analysis.
(07) Arab et al.(²⁰20 Arab Z, Shariati AR, Asayesh H, Vakili MA, Bahrami-Taghanaki H, Azizi H. A sham-controlled trial of acupressure on the quality of sleep and life in haemodialysis patients. BMJ Journals [Internet]. 2015 [cited 2017 Sep 20]; Available from: http://aim.bmj.com/content/early/2015/07/26/acupmed-2014-010369.full http://aim.bmj.com/content/early/2015/07... ), 2015	To investigate the effect of acupuncture on the sleep quality of patients with CKD.N=108	Blind, appropriately selected and randomized in GE (auriculotherapy), Placebo (acupuncture auriculotherapy out of the acupoint) and GC (routine care). It does not describe follow-up losses. Provides necessary information on data collection and analysis.
(08) Shariati et al. (²¹21 Shariati A, Jahani S, Hooshmand M, Khalili N. The effect of acupressure on sleep quality in hemodialysis patients. Complement Ther Med [Internet]. 2012 [cited 2017 Sep 3];20(6):417-23. Available from: https://www.sciencedirect.com/science/article/pii/S0965229912001161?via%3Dihub https://www.sciencedirect.com/science/ar... ), 2012	To search the effect of acupuncture on the sleep quality of patients with CKD.N=48	Double-blind, adequately selected and randomized in GE (systemic acupuncture) and GC (routine care). It describes follow-up losses and presents necessary information on data collection and analysis.
(09) Eğlence et al.(²²22 Eglence R, Karatas N, Tasci S. The effect of acupressure on the level of fatigue in hemodialysis patients. Altern Ther Health Med.[Internet].2013 [cited 2018Sep 3];19(6):23-31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24254035 https://www.ncbi.nlm.nih.gov/pubmed/2425... ), 2013	To determine the effect of acupuncture on the level of fatigue in CKD.N=118	Patients adequately selected and randomized. It does not describe blinding technique. The patients were divided into GE (systemic acupuncture) and GC (routine care). It describes follow-up losses and presents necessary information on data collection and analysis.

Nº	Type of therapy and time of intervention	Clinical outcomes
01	Auriculotherapy once a week/three months. Shenmen, Kidney, Heart and Spleen stimulation from three to five times/day/two minutes.	Patients in the experimental group presented better quality of life (60.2 versus 76.6, p <0.001); in the control group, there was no significant improvement (58.9 and 61.8, p=0.274).
02	Electroacupuncture once a week for 12 weeks, with electrical stimulation for 20 minutes in LI4, S36 and K3.	Baseline serum creatinine levels were 1.45 mg/dL in GI and 1.67 mg/dL in GC (p=0.128). After treatment with acupuncture, it was 1.41 mg/dL in the GI; 1.65 mg/dL, in the GC (p=0.0489). The baseline GFR was 51.85 mL/min/1.73 m2 in the GI; 42.50 mL/min/1.73 m2, in GC (p=0.0855). After treatment with acupuncture, it was 54.50 mL/min/1.73m2, in GI; 43.60 mL/min/1.73m2, in GC (p=0.0470).
03	Electroacupuncture for five consecutive weeks, for 50 seconds. Ten sessions two to three times a week in S36, SP6 and LI4.	The mean fatigue score in the GI and CG groups was 30.68 and 26.32, respectively (p=0.317), at the baseline. Significant differences were found between the IG and GC groups, 21.68 and 35.32, respectively, after intervention (p=0.002). When comparing the within groups averages, in GI, there was a statistically significant reduction (p<0.001), when the two moments were compared, whereas in the CG group, there was no significant improvement (p=0.731).
04	Acupressure three times a week, for three minutes, for four weeks in H7, K11, L3.	Both groups demonstrated a reduction in the scores of the Global Sleep Quality Index when compared to the baseline with the fourth week. However, they were not statistically significant (GI: 0.52 to 0.61, 𝑝=0.35, GC: 0.74 to 0.43, 𝑝=0.20). The differences between GI and GC in the overall PSQI score (0.19 versus 1.70, 𝑝=0.8) and on the subscales were small.
05	Auriculotherapy three to five times a day for four weeks in ShenMen, Sympathetic, Subcortex, Heart, Endocrine.	The overall sleep quality index decreased by 3.75 ± 4.36 and 2.26 ± 3.89, after treatment in the IG and CG groups. The results of analyzes of variance of the measures for the global PSQI score showed a reduction over time in in the GI group (F=8.47, p <0.01) and in the CG group (F=4.09, p <0.01). Decrease was also found in all seven domains, except sleep disorders after treatment in the GI group.After the treatment between two groups (follow-up) (χ²=9.63, p<0.01), there was no significant difference between the two groups (χ²=0.77, p=0.38); and at the end of follow-up between two groups (χ²=4.59, p=0.03).
06	Acupressure lasting 20 minutes, three weekly sessions, for four weeks in K1, GB34, S36, SP6, SPL23, H7.	The mean total score and mean fatigue scores in the sensory, behavioral, cognitive and emotional dimensions in both study groups and placebo were lower after intervention (p<0.05). There was a significant difference in the total variation of the mean fatigue score before and after intervention within groups (GI: 6.5 versus 4.6 (p<0.001), GP: 6.4 versus 5.9 (p<0.001), and GC: 6.4 versus 6.3 (p=0.43)) and after intervention between the three groups ANOVA F = 60,012 and p<0.001.
07	Acupressure lasting eight minutes three times a week for four weeks in H7.	The total score was not different between the groups before the study (p>0.05, ANOVA). The Pittsburgh Sleep Quality Score decreased significantly: from 11.9 ± 3.13 to 6.2 ± 1.93 for GI, from 11.3 ± 3.69 to 10.6 ± 3.82 in the GP, and from 10.9 ± 4.10 to 10.7 ± 3.94 in GC. There was a significant difference between groups (p<0.001). There was a significant difference between the three groups in the number of nocturnal awakenings, before and after the study (p<0.001).
08	Acupressure three times a week for four weeks for 15 minutes in H7, LI4 and SP6.	The results showed significant differences in the overall score (p <0.001) and all sleep quality indices: subjective sleep quality (p<0.001), sleep latency (p<0.001), sleep duration (p<0.001), (p=0.028), and diurnal dysfunction (p<0.001), when the two groups were compared.
09	Electroacupuncture three times a week for four weeks at points S36, GB34, K1 and SP6.	The mean score on the visual analogue scale for fatigue in EG decreased from 7.6 at baseline to 5.0 at follow-up; while for GC, the mean fatigue score increased from 6.7 at baseline to 8.0, with p<0.01.

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[1] Corresponding author: Geórgia Alcântara Alencar Melo E-mail: georgiaenf@hotmail.com