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Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy
Jenny Chun-Ling Guo1, Heng-Chih Pan2,3, Bo-Yan Yeh4
1Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Chinese herbal medicine (CHM) use in pre-dialysis diabetic nephropathy (DN) patients was associated with significantly lower risks of mortality and end-stage renal disease (ESRD). Further clinical trials are needed to confirm these beneficial effects.
Area of Science:
- Nephrology
- Integrative Medicine
- Pharmacology
Background:
- Chronic kidney disease (CKD) presents a global health challenge, with diabetic nephropathy (DN) being a primary driver.
- Pre-dialysis is a critical stage for managing DN patients before progression to end-stage renal disease (ESRD).
- The role and impact of Chinese herbal medicine (CHM) in pre-dialysis DN patient care remain under-explored.
Purpose of the Study:
- To investigate the association between CHM use and long-term outcomes in pre-dialysis DN patients.
- To analyze CHM prescriptions and identify core herbal components used in this patient population.
- To evaluate the impact of core CHM usage on patient mortality.
Main Methods:
- Analysis of a population-based cohort from Taiwan's National Health Insurance Research Database (2004-2007).
- Inclusion of incident pre-dialysis DN patients with a 5-year follow-up period.
- Statistical analysis using Kaplan-Meier, competing risk estimation, and Chinese herbal medicine network (CMN) analysis.
Main Results:
- CHM users (877) showed significantly lower all-cause mortality (0.42 hazard ratio) compared to non-users (5,771).
- CHM use was associated with a reduced risk of ESRD (0.59 hazard ratio).
- Core CHMs, including Ji-Sheng-Shen-Qi-Wan and specific herbs like Astragalus, Plantago, Salvia, and Rheum, were identified, with their use linked to lower mortality.
Conclusions:
- CHM use appears feasible and potentially beneficial for pre-dialysis DN patients.
- CHM may reduce mortality and slow progression to ESRD in this cohort.
- Rigorous clinical trials are necessary to validate the efficacy of CHM in managing pre-dialysis DN.
Abstract:
Background: Chronic kidney disease (CKD) has become a worldwide burden due to the high co-morbidity and mortality. Diabetic nephropathy (DN) is one of the leading causes of CKD, and pre-dialysis is one of the most critical stages before the end-stage renal disease (ESRD). Although Chinese herbal medicine (CHM) use is not uncommon, the feasibility of using CHM among pre-dialysis DN patients remains unclear. Materials and methods: We analyzed a population-based cohort, retrieved from Taiwan's National Health Insurance Research Database, to study the long-term outcome of using CHM among incident pre-dialysis DN patients from January 1, 2004, to December 31, 2007. All patients were followed up to 5 years or the occurrence of mortality. The risks of all-cause mortality and ESRD were carried out using Kaplan-Meier and competing risk estimation, respectively. Further, we demonstrated the CHM prescriptions and core CHMs using the Chinese herbal medicine network (CMN) analysis. Results: A total of 6,648 incident pre-dialysis DN patients were analyzed, including 877 CHM users and 5,771 CHM nonusers. With overlap weighing for balancing all accessible covariates between CHM users and nonusers, we found the use of CHM was associated with lower all-cause mortality (0.22 versus 0.56; log-rank test: p-value <0.001), and the risk of mortality was 0.42 (95% CI: 0.36-0.49; p-value <0.001) by adjusting all accessible covariates. Further, the use of CHM was associated with a lower risk of ESRD (cause-specific hazard ratio: 0.59, 95%CI: 0.55-0.63; p-value <0.001). Also, from the 5,901 CHM prescriptions, we found Ji-Sheng-Shen-Qi-Wan, Astragalus mongholicus Bunge or (Astragalus membranaceus (Fisch.) Bge.), Plantago asiatica L. (or Plantago depressa Willd.), Salvia miltiorrhiza Bunge, and Rheum palmatum L. (or Rheum tanguticum (Maxim. ex Regel) Balf., Rheum officinale Baill.) were used as core CHMs for different CHM indications. Use of core CHMs was associated with a lower risk of mortality than CHM users without using core CHMs. Conclusions: The use of CHM seemed feasible among pre-dialysis DN patients; however, the beneficial effects still need to be validated by well-designed clinical trials.
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