Prescription profile of potentially aristolochic acid containing Chinese herbal products: an analysis of National Health Insurance data in Taiwan between 1997 and 2003

Hsieh, Shu‐Ching; Lin, I‐Hsin; Tseng, Wei-Lum; Lee, Chang-Hsing; Wang, Jung‐Der

doi:10.1186/1749-8546-3-13

Cited by 76 publications

(82 citation statements)

References 26 publications

(20 reference statements)

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“…accord with findings in human populations, where only a small fraction of AA-exposed individuals develop renal toxicity and/or urothelial cancer (4,23,24). The genetic basis for such relative susceptibility is yet to be determined.…”

Section: Discussionsupporting

confidence: 69%

Human liver-kidney model elucidates the mechanisms of aristolochic acid nephrotoxicity

Chang¹,

et al. 2017

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Section: Discussionsupporting

confidence: 69%

Human liver-kidney model elucidates the mechanisms of aristolochic acid nephrotoxicity

Chang¹,

et al. 2017

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“…This national reimbursement database has been used to conduct largescale, population-based, case-control studies designed to examine the association between AA-containing herbal products and the risk of developing urothelial cancer and chronic renal disease. Using this approach, more than half of the 23 million residents of Taiwan were estimated to have used Chinese herbal remedies between 1997 and 2003, with more than one-third of the entire population using herbs containing, or likely to contain, AA (14). Additionally, these population-based studies documented a linear dose-response relationship between exposure to AA-containing herbs and the risk of developing urinary tract cancers (13) or end-stage renal failure (15).…”

Section: Discussionmentioning

confidence: 96%

“…dA-AL-I adducts also are present in 60% of patients with RCC; however, in this control group, A:T to T:A approximately one-third of the population of Taiwan has been exposed to Chinese medicinal herbs containing, or likely to contain, AA (13)(14)(15), and that a linear dose-response relationship exists between consumption of herbal remedies containing AA and the risk of developing urinary tract cancer. These epidemiologic studies likely underestimate AA exposure because they consider only Aristolochia-based prescriptions written by physicians over a period of 7 y, and Aristolochia herbs have long been available in Taiwan from alternative sources.…”

Section: Discussionmentioning

confidence: 99%

“…The high level of exposure to AA in Taiwan has been documented by a systematic analysis of prescriptions filled by a 200,000 person random sample of the entire insured population of Taiwan between 1997 and 2003, revealing that approximately one-third of these individuals consumed herbs containing, or likely to contain, AA (14). Moreover, consumption of AA is associated, in a dosedependent manner, with an increased risk of developing end-stage renal disease or urothelial carcinoma (13,15).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Aristolochic acid-associated urothelial cancer in Taiwan

Chen

Dickman

Moriya³

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

352

391

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Aristolochic acid, a potent human carcinogen produced by Aristolochia plants, is associated with urothelial carcinoma of the upper urinary tract (UUC). Following metabolic activation, aristolochic acid reacts with DNA to form aristolactam (AL)-DNA adducts. These lesions concentrate in the renal cortex, where they serve as a sensitive and specific biomarker of exposure, and are found also in the urothelium, where they give rise to a unique mutational signature in the TP53 tumor-suppressor gene. Using AL-DNA adducts and TP53 mutation spectra as biomarkers, we conducted a molecular epidemiologic study of UUC in Taiwan, where the incidence of UUC is the highest reported anywhere in the world and where Aristolochia herbal remedies have been used extensively for many years. Our study involves 151 UUC patients, with 25 patients with renal cell carcinomas serving as a control group. The TP53 mutational signature in patients with UUC, dominated by otherwise rare A:T to T:A transversions, is identical to that observed in UUC associated with Balkan endemic nephropathy, an environmental disease. Prominent TP53 mutational hotspots include the adenine bases of 5′ AG (acceptor) splice sites located almost exclusively on the nontranscribed strand. A:T to T:A mutations also were detected at activating positions in the FGFR3 and HRAS oncogenes. AL-DNA adducts were present in the renal cortex of 83% of patients with A:T to T:A mutations in TP53, FGFR3, or HRAS. We conclude that exposure to aristolochic acid contributes significantly to the incidence of UUC in Taiwan, a finding with significant implications for global public health.upper urinary tract carcinoma | traditional Chinese medicine | transitional cell carcinoma | DNA damage | herbal medicine

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“…This combined Chinese herb formula, which includes Mu Tong, possibly contains aristolochic acid. Use of Chinese herbs containing aristolochic acid was not uncommon before it was banned in 2003; this substance accounted for 3% of all qualified prescriptions at Taiwan (31). Given that a large proportion of consumers tend to be unfamiliar with the ingredients of the Chinese herbs they were taking and very few are prescribed to take the formula Long Dan Xie Gan Tang, this result is needed to be reconfirmed in the future.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with CKD in the Elderly and Nonelderly Population

Lin

Chiu

Lee³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The risk factors for CKD in different age groups remain unknown. This communitybased study aimed to identify the risk factors for CKD in elderly and nonelderly patients.Design, setting, participants, & measurements A multistage sampling survey for CKD was conducted in 2007 in Kaohsiung County, an area with the highest prevalence of dialysis in the world. CKD was defined as proteinuria in at least the microalbuminuric stage or an estimated GFR (eGFR) of ,60 ml/min per 1.73 m 2 . The factors for CKD in elderly and nonelderly patient groups were identified (with age 60 years as a cutoff value).Results The analyses included 3352 participants, of whom 687 had CKD. The weighted prevalence of CKD was 19.4% (95% confidence interval [CI], 18.0%-20.7%). Elderly patients typically presented with low eGFR and nonelderly patients, with proteinuria. Age, annual income, use of oral analgesics, metabolic syndrome, hyperuricemia, and hemoglobin were risk factors for CKD in both age groups. In elderly patients, risk factors were medical history of diabetes mellitus, CKD, stroke, and not using analgesic injection (odds ratios [

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Prescription profile of potentially aristolochic acid containing Chinese herbal products: an analysis of National Health Insurance data in Taiwan between 1997 and 2003

Cited by 76 publications

References 26 publications

Human liver-kidney model elucidates the mechanisms of aristolochic acid nephrotoxicity

Human liver-kidney model elucidates the mechanisms of aristolochic acid nephrotoxicity

Aristolochic acid-associated urothelial cancer in Taiwan

Factors Associated with CKD in the Elderly and Nonelderly Population

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