Meta-analysis of Niaoduqing Granules for uremic pruritus in Chinese hemodialysis patients: efficacy and safety evidence from RCTs.

Background: Uremic pruritus, a common complication in hemodialysis populations, adversely affects quality of life owing to multifactorial etiology. Emerging evidence from traditional Chinese medicine highlights Niaoduqing Granules as a candidate intervention for symptom mitigation. To assess its therapeutic potential, a retrospective meta-analysis was performed to evaluate efficacy and safety profiles in hemodialysis cohorts. These findings aim to inform evidence-based decisions regarding its clinical applicability. Methods: A systematic literature search was conducted across four international biomedical databases (e.g., PubMed, Embase, Web of Science, ClinicalTrials.gov) and three Chinese scholarly platforms (CNKI, Wanfang, CQVIP), with the search window extending through March 2025. We systematically reviewed all available randomized controlled trials (RCTs) investigating the effects of Niaoduqing Granules on uremic pruritus in hemodialysis populations. Results: The final analysis incorporated 14 qualifying studies involving 1,232 participants. Hemodialysis patients receiving Niaoduqing Granules demonstrated a significant reduction in pruritus scores compared to the control group (Visual Analogue Scale: WMD = -2.151; 95% CIs = -2.372 to -1.930; p < 0.001. 5D-itch Scale: WMD = -7.642; 95% CIs = -14.042 to -1.243; p = 0.019). Demonstrates high therapeutic efficacy with a favorable safety profile. This meta-analysis demonstrated clinically meaningful efficacy favoring the Niaoduqing Granule group (RR = 1.249; 95% CIs = 1.169-1.335; p < 0.001), with safety analyses across three trials revealing comparable adverse event rates (R = 1.303; 95% CIs = 0.589-2.884; p = 0.514; I 2 = 0.0%). In addition, in the Niaoduqing Granules group, significant intergroup differences were observed in serum levels of parathyroid hormone, phosphorus, creatinine, blood urea nitrogen, β2-microglobulin, high-sensitivity C-reactive protein, tumor necrosis factor-α, and interleukin-6, all demonstrating statistical significance. Conclusion: Niaoduqing Granules demonstrated efficacy in reducing pruritus severity among hemodialysis patients without increasing drug-related adverse events, while also showing concomitant reductions in inflammatory biomarkers. However, limitations in sample size necessitate further large-scale studies to validate these preliminary findings.