Tao Y., Wang X., Zhang L., Yang M., Wei J., Liu M., Ling M., Wang S. Efficacy and Safety of Bailing Capsule (Cordyceps sinensis) in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2024;15:1372991.
Rationale
C. sinensis preparations (registered in China as Bailing/百令) have long been used in nephrology as adjuvants to slow chronic kidney disease (CKD) progression. Individual RCTs showed nephroprotective effects, but samples were small and results heterogeneous. A systematic pooling quantifies the effect and marks its limits.
Methods
Search of PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP through January 2024. Included: RCTs of Bailing (Cordyceps sinensis) in adults with CKD stages 1–5, including hemodialysis, vs. placebo or usual care. Primary outcomes: eGFR, proteinuria (24-hour urinary protein), serum creatinine, blood urea, fatigue severity. Secondary: adverse effects, quality of life, need for renal replacement therapy. RCT quality assessed by the Cochrane scale; random-effects meta-analysis (DerSimonian–Laird); heterogeneity by I²; sensitivity by leave-one-out.
Results
32 RCTs included (n=2392, range n=40–220). Versus control, Bailing significantly: raised eGFR (MD 6.3 ml/min/1.73 m²; 95% CI 4.8–7.8; p < 0.001), lowered 24-hour proteinuria (MD −0.42 g/day; 95% CI −0.55 to −0.29; p < 0.001), lowered serum creatinine (MD −32.4 µmol/L; 95% CI −45.1 to −19.7; p < 0.001) and urea (MD −1.8 mmol/L; 95% CI −2.4 to −1.2; p < 0.001). In hemodialysis patients Bailing significantly reduced fatigue on FACIT-F and Piper scales. Adverse-effect frequency did not differ from control. Heterogeneity I² across outcomes was 35–68% — moderate inconsistency; most included RCTs were Chinese single-center studies with short follow-up (8–24 weeks).
Conclusions
The meta-analysis confirms that Bailing (Cordyceps sinensis) as an adjuvant to standard nephrological therapy significantly improves functional kidney markers and reduces proteinuria in CKD stages 1–5, including hemodialysis, without additional adverse effects. Long-term outcomes (dialysis delay, survival) are unproven; large multicenter RCTs with extended follow-up are needed for firm recommendations.
Worth noting
Most included RCTs were conducted in China, and generalizability to non-Asian populations is unproven. Bailing is standardized but is not identical to wild Tibetan C. sinensis: it is fermented mycelium, which matters when extrapolating to western supplements (often extracts of other strains). The eGFR effect (+6.3 ml/min/1.73 m²) is clinically meaningful, but heterogeneity I² > 50% for some outcomes lowers confidence; the authors stress the need for prolonged western RCTs. Still, for an evidence-oriented reader this is the most complete pooling of clinical data on C. sinensis in nephrology.