Efficacy of Danggui Shaoyao San combined with piperazine ferulate tablets in the treatment of early-stage chronic renal failure based on ultrasound images evaluation

To optimize clinical strategies, this study evaluated the efficacy of Danggui Shaoyao San (DSS) combined with piperazine ferulate (PF) tablets in treating early-stage chronic renal failure (CRF) using a comprehensive approach including renal ultrasound imaging alongside biochemical, hemodynamic, and immunologic assessments. A total of 85 patients were randomly assigned to the group PF (treated with piperazine ferulate, n = 42) and the PF + DSS group (treated with piperazine ferulate combined with Danggui Shaoyao San, n = 43) using the random number table method. This study compared differences in the following parameters: the renal fibrosis markers transforming growth factor (TGF)-β1, hypoxia-inducible factor (HIF)-1α, and fibronectin (FN); renal function indicators serum creatinine (SCr) and blood urea nitrogen (BUN); hemodynamic parameters including whole blood viscosity (WBV), whole blood low-shear viscosity (WBLSV), whole blood high-shear viscosity (WBHSV), and hematocrit (HCT); and the Treg/Th17 cell ratio measured by flow cytometry. Renal ultrasound images were used to assess the renal artery resistance index, kidney size, cortical thickness, and blood flow grading. The PF + DSS group exhibited a higher overall response rate (defined as the sum of markedly effective, effective, and stable cases) than the PF group (93.03 % vs. 76.19 %, P < 0.05). Compared to the PF group, the PF + DSS group showed significant improvements in biochemical markers (significant reductions in TGF-β1, HIF-1α, FN, SCr, BUN, and 24-h urinary protein, alongside a significant increase in eGFR), hemodynamics (significant reductions in WBV, WBLSV, WBHSV, and HCT), renal ultrasound parameters (significant reduction in renal artery RI, increased renal cortical thickness, and improved blood flow grading), and immune function (increased Treg cell proportion and decreased Th17 cell proportion) ( P < 0.05). Furthermore, responders (markedly effective/effective) in the PF + DSS group showed significantly greater reductions in renal artery RI and serum TGF-β1 compared to non-responders (stable/ineffective) ( P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). The combination of DSS and PF is more effective than PF monotherapy in improving renal function, hemodynamics, ultrasonographic structure, and immune balance in early-stage CRF, with a favorable safety profile, highlighting its promise as an integrated treatment.