Four prescribed Chinese herbal medicines provide renoprotection and survival benefit without hyperkalemia risk in patients with advanced chronic kidney disease: a nationwide cohort study

As the current treatment of chronic kidney disease (CKD) is limited, it is necessary to seek more effective and safer treatment methods, such as Chinese herbal medicines (CHMs). In order to clarify the modern theoretical basis and molecular mechanisms of CHMs, we reviewed the knowledge based on publications in peer-reviewed English-language journals, focusing on the anti-inflammatory, antioxidative, anti-apoptotic, autophagy-mediated and antifibrotic effects of CHMs commonly used in kidney disease. We also discussed recently published clinical trials and meta-analyses in this field. Based on recent studies regarding the mechanisms of kidney disease in vivo and in vitro, CHMs have anti-inflammatory, antioxidative, anti-apoptotic, autophagy-mediated, and antifibrotic effects. Several well-designed randomized controlled trials (RCTs) and meta-analyses demonstrated that the use of CHMs as an adjuvant to conventional medicines may benefit patients with CKD. Unknown active ingredients, low quality and small sample sizes of some clinical trials, and the safety of CHMs have restricted the development of CHMs. CHMs is a potential method in the treatment of CKD. Further study on the mechanism and well-conducted RCTs are urgently needed to evaluate the efficacy and safety of CHMs.

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Non-aristolochic acid prescribed Chinese herbal medicines and the risk of mortality in patients with chronic kidney disease: results from a population-based follow-up study

BMJ Open ◽

10.1136/bmjopen-2013-004033 ◽

2014 ◽

Vol 4 (2) ◽

pp. e004033 ◽

Cited By ~ 16

Author(s):

Chuan Fa Hsieh ◽

Song Lih Huang ◽

Chien Lung Chen ◽

Wei Ta Chen ◽

Huan Cheng Chang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Aristolochic Acid ◽

Herbal Medicines ◽

Population Based ◽

Chinese Herbal Medicines ◽

Follow Up Study ◽

Chinese Herbal ◽

Risk Of Mortality

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Prescribed Renoprotective Chinese Herbal Medicines Were Associated with a Lower Risk of All-Cause and Disease-Specific Mortality among Patients with Chronic Kidney Disease: A Population-Based Follow-Up Study in Taiwan

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/5632195 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Chuan-Fa Hsieh ◽

Huan-Cheng Chang ◽

Song-Lih Huang ◽

Chien-Lung Chen ◽

Wei-Ta Chen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Lower Risk ◽

Salvia Miltiorrhiza ◽

Herbal Medicines ◽

Population Based ◽

Cordyceps Sinensis ◽

Angelica Sinensis ◽

Chinese Herbal Medicines ◽

Chinese Herbal

Chinese herbal medicines (CHMs) containing aristolochic acid (AA) are associated with chronic kidney disease (CKD), but some prescribed CHMs have been shown to possess renoprotective effects. We conducted a nationwide retrospective cohort study to delineate the role of prescribed CHMs on the CKD progression. Renoprotective CHM (RPCHM) was defined if a CHM contained dong chong xia cao (Cordyceps sinensis (Berk.) Sacc.), da huang (Rheum palmatum L), huang qi (Astragalus membranaceus), dan shen (Salvia miltiorrhiza Bge.), and dong quai (Angelica sinensis (Oliv.) Diels) or belonged to specific mixture herbal formulations (Yishen capsule, Saireito, or Wen Pi Tang). Subjects who had ever used AA-containing CHMs, had cancer or HIV prior to CKD diagnosis, or died within the first month of CKD diagnosis were excluded. A total of 11,625 patients were eligible subjects. The adjusted hazard ratio (aHR) for all-cause mortality was 0.6 (p < 0.001) and 0.6 (p = 0.013) among subjects receiving RPCHMs containing Angelica sinensis and those receiving other RPCHMs, respectively. For CKD-related mortality, the aHR among subjects receiving RPCHMs containing Angelica sinensis was 0.6 (p = 0.025). The use of specific RPCHMs, especially those that contained Angelica sinensis, was associated with a lower risk of mortality among CKD patients.

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New Insights Into the Effects of Individual Chinese Herbal Medicines on Chronic Kidney Disease

Frontiers in Pharmacology ◽

10.3389/fphar.2021.774414 ◽

2021 ◽

Vol 12 ◽

Author(s):

Minghai Shao ◽

Chaoyang Ye ◽

George Bayliss ◽

Shougang Zhuang

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Efficacy ◽

Chronic Renal Disease ◽

Salvia Miltiorrhiza ◽

Herbal Medicines ◽

Chinese Herbs ◽

Clinical Effects ◽

Chinese Herbal Medicines ◽

Chinese Herbal

The clinical and experimental study into the effects of Chinese herbal medicines on chronic kidney disease has evolved over the past 40 years with new insight into their mechanism and evidence of their clinical effects. Among the many traditional Chinese herbs examined in chronic renal disease, five were found to have evidence of sufficient clinical efficacy, high frequency of use, and well-studied mechanism. They are: Abelmoschus manihot and Huangkui capsule, Salvia miltiorrhiza and its components (tanshinone II A, salvianolic acid A and B); Rhizoma coptidis and its monomer berberine; Tripterygium wilfordii and its components (triptolide, tripterygium glycosides); Kudzu root Pueraria and its monomer Puerarin. These Chinese herbal medications have pharmaceutical effects against fibrosis, inflammation and oxidative stress and also promote renal repair and regeneration. This article reviews their clinical efficacy, anti-fibrotic effects in animal models, and molecular mechanism of action.

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CL1 ASSOCIATION BETWEEN DIABETES MEDICATION USE AND CARDIOVASCULAR EVENTS AMONG TYPE 2 DIABETES PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE: A NATIONWIDE COHORT STUDY.

Value in Health ◽

10.1016/j.jval.2019.09.053 ◽

2019 ◽

Vol 22 ◽

pp. S407

Author(s):

H.C. Chang ◽

H.M. Cheng ◽

P.Y. Chang ◽

C.E. Chiang ◽

Y.W. Tsai

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiovascular Events ◽

Medication Use ◽

Advanced Chronic Kidney Disease ◽

Diabetes Medication ◽

Diabetes Patients

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Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031550 ◽

2019 ◽

Vol 9 (8) ◽

pp. e031550 ◽

Cited By ~ 10

Author(s):

Austin G Stack ◽

Michelle Elizabeth Johnson ◽

Betina Blak ◽

Alyssa Klein ◽

Lewis Carpenter ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Serum Creatinine ◽

International Classification Of Diseases ◽

Secondary Outcome ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Advanced Chronic Kidney Disease ◽

National Cohort

ObjectiveEvaluate the association between gout and risk of advanced chronic kidney disease (CKD).DesignRetrospective matched cohort study.SettingUK Clinical Practice Research Datalink.ParticipantsThe analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged ≥18 years, registered at UK practices, had ≥12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.Primary and secondary outcome measuresAdvanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine from baseline and (4) death associated with CKD.ResultsAdvanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).ConclusionsGout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.

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