The effect of pentoxifylline on proteinuria in diabetic kidney disease: a meta-analysis

Am J Kidney Dis. 2008 Sep;52(3):454-63. doi: 10.1053/j.ajkd.2008.01.025. Epub 2008 Apr 22.


Background: Pentoxifylline is a potential therapeutic agent for diabetic kidney disease because it has anti-inflammatory, antifibrotic, and hemorheological properties.

Study design: Systematic review and meta-analysis of randomized controlled trials.

Setting, population, & intervention: Adult patients with diabetic kidney disease who received oral pentoxifylline.

Selection criteria for studies: We searched bibliographic databases for trials involving pentoxifylline that reported proteinuria, glomerular filtration rate, or blood pressure.

Outcomes: The primary outcome measure was the effect of pentoxifylline on proteinuria stratified by whether pentoxifylline was compared with renin-angiotensin system blockade.

Results: 10 studies including a total of 476 participants with a median duration of 6 months were identified. Pentoxifylline significantly decreased proteinuria (weighted mean difference, -278 mg/d of protein; 95% confidence interval [CI], -398 to -159; P < 0.001) compared with placebo or usual care. Compared with captopril, the decrease in proteinuria with pentoxifylline was similar (weighted mean difference, 0 mg/d of protein; 95% CI, -17 to 18; P = 0.9). Secondary analysis showed that patients with microalbuminuria had a nonsignificant decrease in protein excretion (weighted mean difference, -87 mg/d; 95% CI, -201 to 27; P = 0.1), whereas those with overt proteinuria (protein > 300 mg/d) had a significant decrease (weighted mean difference, -502 mg/d; 95% CI, -805 to -198; P = 0.001). No significant changes in systolic or diastolic blood pressure or glomerular filtration rate were found.

Limitations: Quality scores of studies were low, and there was significant heterogeneity.

Conclusions: Available evidence suggests that pentoxifylline may decrease proteinuria in patients with diabetic nephropathy. To confirm these findings, large high-quality studies are required.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Albuminuria / etiology
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Blood Pressure
  • Captopril / adverse effects
  • Captopril / therapeutic use
  • Diabetic Nephropathies / complications*
  • Humans
  • Kidney / physiopathology
  • Pentoxifylline / adverse effects
  • Pentoxifylline / therapeutic use*
  • Phosphodiesterase Inhibitors / adverse effects
  • Phosphodiesterase Inhibitors / therapeutic use*
  • Proteinuria / drug therapy*
  • Proteinuria / etiology*
  • Proteinuria / physiopathology


  • Angiotensin-Converting Enzyme Inhibitors
  • Phosphodiesterase Inhibitors
  • Captopril
  • Pentoxifylline