To systematically evaluate the clinical efficacy and safety of pentoxifylline(PTX) combined with ACEI/ARB drugs in the treatment of diabetic kidney disease, and provide new evidence-based data for pentoxifylline in the treatment of diabetic kidney disease.

Chinese and foreign language databases were retrieved including CNKI, Wanfang, EMBASE, PubMed, and Cochrane Library, etc. The retrieval was from the establishment of the database to February 20, 2021. All the included documents were randomized controlled trials. The differences in urine protein, renal function, glucose metabolism, blood pressure and adverse reactions between the treatment group (pentoxifylline and conventional treatment combined with ACEI/ARB) and the control group (conventional treatment combined with ACEI/ARB) were compared.Rev Man 5.3 software was used for meta-analysis.

A total of 18 randomized controlled trials were included, with a total of 1 401 patients with type 2 diabetic nephropathy, including 724 cases in the treatment group and 677 cases in the control group. Meta-analysis results showed that compared with the control group, the treatment group significantly reduced the 24-hour urine protein (WMD=-0.53, 95%CI: -0.58 to -0.49, P<0.001), systolic blood pressure (WMD=-1.97, 95%CI: -3.51 to -0.44, P=0.01), fasting blood glucose (WMD=-0.32, 95%CI: -0.58 to -0.06, P=0.01), and glycated hemoglobin (WMD=-0.2, 95%CI: -0.32 to -0.08, P<0.01), while no severe adverse reactions were found in both two groups.

Pentoxifylline combined with ACEI/ARB drugs was superior to ACEI/ARB drugs alone in improving the proteinuria, systolic pressure, and sugar metabolism of patients with diabetic kidney disease, showing better clinical efficacy. Clinical randomized controlled trials of high-quality, multi-center, and large-sample are still needed for further confirmation.