Traditional Chinese medicine use is associated with lower end-stage renal disease and mortality rates among patients with diabetic nephropathy: a population-based cohort study

Abstract

Background Diabetic nephropathy (DN) is a common complication of diabetes mellitus (DM) that imposes an enormous burden on the healthcare system. Although some studies show that traditional Chinese medicine (TCM) treatments confer a protective effect on DN, the long-term impact remains unclear. This study aims to examine end-stage renal disease (ESRD) and mortality rates among TCM users with DN. Methods A total of 125,490 patients with incident DN patients from 2004 to 2006 were identified from the National Health Insurance Research Database in Taiwan and followed until 2012. The landmark method was applied to avoid immortal time bias, and propensity score matching was used to select 1:1 baseline characteristics-matched cohort. The Kaplan–Meier method and competing-risk analysis were used to assess mortality and ESRD rates separately. Results Among all eligible subjects, about 60% of patients were classified as TCM users (65,812 TCM users and 41,482 nonusers). After 1:1 matching, the outcomes of 68,882 patients were analyzed. For the ESRD rate, the 8-year cumulative incidence was 14.5% for TCM users [95% confidence interval (CI): 13.9–15.0] and 16.6% for nonusers (95% CI: 16.0–17.2). For the mortality rate, the 8-year cumulative incidence was 33.8% for TCM users (95% CI: 33.1–34.6) and 49.2% for nonusers (95% CI: 48.5–49.9). After adjusting for confounding covariates, the cause-specific hazard ratio of ESRD was 0.81 (95% CI: 0.78–0.84), and the hazard ratio of mortality for TCM users was 0.48 (95% CI: 0.47–0.50). The cumulative incidence of mortality increased rapidly among TCM users with ESRD (56.8, 95% CI: 54.6–59.1) when compared with TCM users without ESRD (30.1, 95% CI: 29.4–30.9). In addition, TCM users who used TCM longer or initiated TCM treatments after being diagnosed with DN were associated with a lower risk of mortality. These results were consistent across sensitivity tests with different definitions of TCM users and inverse probability weighting of subjects. Conclusions The lower ESRD and mortality rates among patients with incident DN correlates with the use of TCM treatments. Further studies about specific TCM modalities or medications for DN are still needed. Electronic supplementary material The online version of this article (10.1186/s12906-019-2491-y) contains supplementary material, which is available to authorized users.

Chinese Herbal Medicine in Ameliorating Diabetic Kidney Disease via Activating Autophagy

“…f. extracts [45]. Besides, a population-based cohort study by Chen et al revealed that Chinese herbal remedies lowered ERSD and mortality rates among DKD patients [46]. Recent studies on DKD suggest certain Chinese herbal agents exert autophagy-inducing functions [18], implying autophagy activation may act as a potential target for its renoprotective action in DKD therapy; meanwhile, the mechanisms of how herbal medicine exerts renal benefits on DKD are addressed through different pathways related to autophagy mainly involving mTOR, AMPK, and Sirt1 (Table 1).…”

Association of Infection With Human Papillomavirus and Development of End-Stage Kidney Disease in Taiwan

“…Additionally, a previous study in a Taiwanese cohort revealed that the 8-year cumulative incidence in the ESKD rate among individuals with diabetic nephropathy was 14.5% (95% CI, 13.9-15.0) for people using traditional Chinese medicine and 16.6% (95% CI, 16.0-17.2) for people who did not use traditional Chinese medicine . 12 A 2017 study 13 found that in a Taiwanese population, a family history of ESKD was a risk factor associated with developing ESKD, suggesting a moderate level of heritability in the Taiwanese population. In addition to well-known risk factors of ESKD, such as diabetes, hypertension, dyslipidemia, and advanced age, infection-related kidney disease has become a subject of recent research.…”

Pharmacokinetics and Pharmacodynamics of the Combination of Rhein and Curcumin in the Treatment of Chronic Kidney Disease in Rats

“…Curcumin, mainly derived from dried rhizome of Curcuma longa L , possesses multiple pharmacological abilities, including anticancer, anti-inflammatory, antioxidation, antifibrotic, anti-arthritis ( Hatcher et al, 2008 ; Azhdari et al, 2019 ), as well as a neuroprotective effect ( Sun et al, 2017 ). Both rhein and curcumin have antifibrotic activity and have showed good efficacy to prevent the progress of renal fibrosis ( Kuwabara et al, 2006 ; He et al, 2011 ; Soetikno et al, 2013 ; Zhou et al, 2014 ; Ho et al, 2016 ; Hu et al, 2016 ; Zhang et al, 2016 ; Chen et al, 2019b ). Therefore, further investigation of the antifibrosis effect of rhein and curcumin was of great significance for the development of new antifibrosis drugs.…”