Impact of liuwei dihuang pills (decoction) on early diabetic nephropathy: a systematic review and meta-analysis

Objective: To systematically evaluate the efficacy and safety of Liuwei Dihuang Pills (Decoction) combined with conventional Western medicine in the treatment of early diabetic nephropathy. Methods: Randomized controlled trials (RCTs) on Liuwei Dihuang Pills (Decoction) combined with conventional treatment for early diabetic nephropathy were retrieved from major domestic and foreign databases from their inception to December 2025. Two researchers independently conducted literature screening, data extraction, and bias risk assessment. Meta-analysis was performed using Reviewer Manager 5.4 software. The primary outcome indicator was urinary albumin excretion rate (UAER); secondary outcomes included renal function indicators, total effective rate, and adverse events. Results: = 0.99), and most reported events were mild to moderate. However, incomplete safety reporting limits the reliability of this finding. Conclusion: Liuwei Dihuang Pills (Decoction) combined with conventional Western medicine may provide additional benefits for patients with early diabetic nephropathy, showing potential advantages in improving objective renal function indicators and clinical outcomes. The available safety data suggest no significant increase in adverse events, but this finding is limited by incomplete reporting across the included studies. Due to the limited sample size, insufficient methodological quality (including lack of allocation concealment and blinding), and high heterogeneity in some analyses, and incomplete adverse event reporting, the overall evidence quality is low. High-quality, large-sample, multi-center RCTs with rigorous methodological design and standardized safety reporting are still needed to further verify the above conclusions. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280431, identifier: CRD420261280431.