Traditional Chinese Medicine Research in Chronic Kidney Disease: Challenges and Future Perspectives

Regardless of recent progress, there is still unmet need for the treatment of chronic kidney disease (CKD). This has led to increased interest in using alternative medicine, such as Traditional Chinese Medicine (TCM), to treat CKD, particularly in China and other Asia countries. Indeed, many CKD patients experience improvement of proteinuria and renal function with appropriate TCM management. However, TCM practice is mostly based on the experiences accumulated over years, which has not been proven by modern well-designed clinical trials. Even though the number of TCM-related randomized controlled trials has been increasing in recent years, these studies still suffer from issues such as small sample sizes, inadequate randomization, and a lack of long-term follow-up. Also, trials with TCM in combination with recently approved new drugs have not been done. Additionally, the complexity and variability of TCM formulas, combined with a lack of standardized quality control for herbs and the heterogeneity of TCM practices, make the study designs very challenging. Safety concerns also arise owing to insufficient systematic monitoring and reporting of potential adverse herb-drug interactions and the nephrotoxicity of certain herbs. TCM uses a holistic medical approach; however, the underlying molecular mechanisms remain unclear. Most published studies are limited to examining the anti-inflammatory and antioxidative stress effects without knowing the exact targets of these drugs and the precise bioactive compounds are often not well defined. In this review, we discuss the challenges and opportunities related to the clinical and basic science research in the field of TCM and describe the pros and cons of several new approaches that have been used in recent years to discover new drugs from TCM.