English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background  Hyperuricemia is an independent risk factor in chronic kidney disease (CKD). Allopurinol and febuxostat are prescription medicines used to treat hyperuricemia but suffer side-effects. Earlier clinical study has shown that an aqueous extract of  Terminalia bellerica  (TBE), significantly reduced uric acid levels with no serious adverse effects in hyperuricemic subjects. The objective of this study is to determine the efficacy and tolerability of TB in reducing uric acid and creatinine levels in CKD subjects.    Methods  59-subjects were randomized to three groups-40 mg-once-daily febuxostat, 500 mg-twice-daily and 1000 mg-twice-daily of TBE. Serum uric acid, creatinine levels and estimated-glometular-filtration-rate were measured at baseline, 4, 8, 12, 16, 20, 24-weeks. Biomarkers of oxidative-stress, endothelial function, systemic inflammation, and platelet-aggregation were evaluated at baseline, 4, 8, 12, 24-weeks. Adverse drug reactions were recorded. Statistical analysis evaluated using GraphPadPrism4.    Results  55-subjects completed 24-week study. Starting at 4-weeks, all treatment groups showed a significant decrease in serum uric acid levels from baseline ( p  ≤ 0.0001). At 24-weeks, febuxostat,  T.bellerica  500 mg-twice-daily, and  T.bellerica  1000 mg-twice-daily doses decreased mean-percentage serum uric acid by 63.70 ± 4.62, 19.84 ± 6.43 and 33.88% ± 4.95% respectively ( p  ≤ 0.0001). Significant decrease in serum creatinine with all the groups starting at 16-weeks was seen ( p  ≤ 0.005-p ≤ 0.0001). At 24-weeks, the mean-percentage change in creatinine levels was 23.71 ± 12.50, 11.70 ± 9.0, and 24.42 ± 8.14, respectively with febuxostat,  T.bellerica  500 mg-twice-daily and  T.bellerica  1000 mg-twice-daily. Statistically significant ( p  ≤ 0.05) increase in estimated glomerular filtration rate-(eGFR) was seen at 20 ( p  ≤ 0.05) and 24-weeks ( p  ≤ 0.01) for both febuxostat vs  T.bellerica  500 mg-twice-daily and  T.bellerica  1000 mg-twice-daily vs  T.bellerica  500 mg-twice-daily. There was no statistically significant difference between febuxostat and  T.bellerica  1000 mg-twice-daily, with an increase of eGFR of 41.38 and 40.39 ml/min/1.73m 2  respectively, with the inference that  T.bellerica  at 1000 mg-twice-daily dose is as good as febuxostat 40 mg-once-daily. Positive improvements were made by all the groups in endothelial function and the related biomarkers and high-sensitivity C-reactive protein. None of the products showed effect on platelet aggregation.    Conclusion  In this 24-week study Febuxostat 40 mg,  T. bellerica  500 mg-twice-daily and 1000 mg-twice-daily, significantly decreased the serum uric acid and creatinine levels, increased eGFR in CKD subjects.  T. bellerica  500 mg-twice-daily and 1000 mg-twice-daily were one-third and more than half as effective at 24-weeks, respectively.  T. bellerica  extract may be considered a natural alternative for reducing serum uric acid levels.    Trial registration  This study was registered with the Clinical Trials Registry – India (CTRI) with the registration number:  CTRI/2019/11/022093  [Registered on: 21/11/2019] Trial Registered Retrospectively.

bmc complementary medicine and therapies

A randomized, double-blind, positive-controlled, prospective, dose-response clinical study to evaluate the efficacy and tolerability of an aqueous extract of Terminalia bellerica in lowering uric acid and creatinine levels in chronic kidney disease subjects with hyperuricemia