Chinese herbal medicines and chronic kidney disease: a positive outcome in a large patient study in Taiwan

Commentary

Kidney International (2015) 88, 1223–1226; doi:10.1038/ki.2015.300

1. ¹Centre for Kidney Disease Research, School of Medicine, University of Queensland, Brisbane, Australia
2. ²Translational Research Institute, Brisbane, Australia
3. ³Nephrology Center, The Second Clinical College, Guangzhou University of Chinese Medicine and Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China

Correspondence: Glenda C. Gobe, University of Queensland – Centre for Kidney Disease Research, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, Queensland 4102, Australia. E-mail: g.gobe@uq.edu.au

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ABSTRACT

The worth of traditional Chinese herbal medicines for chronic kidney disease (CKD) patients remains in debate. Lin et al. used a research database in Taiwan to identify almost 25,000 stage 3–5 newly diagnosed CKD patients who, after diagnosis, did or did not use prescribed Chinese herbal medicines for CKD. Reduced risk of end-stage kidney disease from specific traditional medicines warrants reflection on a CKD therapy resource that is largely ignored by Western medicine.

Current conventional-medicine treatment options for chronic kidney disease (CKD) are limited in efficacy, and often do not inhibit progression of CKD to end-stage kidney disease (ESKD), an increasing and costly disease in many societies. Nonetheless, there is continuing concern in Western medicine about the value of traditional Chinese herbal medicines as treatments for patients with CKD. Many active components of traditional-medicine formulas are unknown, and their potential toxicities have not yet been resolved. Since the disastrous use of plants with aristolochic acid content (for example, Aristolochia fangchi) in some therapies for weight loss at clinics in Belgium in the early 1990s,¹ where rapidly progressive fibrosing interstitial nephritis and urothelial malignancies developed in treated women, Chinese herbal medicine has been regarded by many Western clinicians with extreme caution. More recently, in an attempt to free the use of traditional Chinese herbal medicines from links, in general, with renal impairment, use of the term ‘Chinese herbs nephropathy’ has been replaced with a more specific descriptor of ‘aristolochic acid-associated nephropathy.² It must be recognized, however, that traditional Chinese herbal medicine forms part of a compendium of drugs offered to CKD patients in many Asian countries. In addition, many patients in the West seek out alternative therapies such as herbal medicines. Thus, the irrefutable use of Chinese herbal medicines suggests the need for practitioners to keep abreast of the most recent information about those therapies. Lin et al.³ (this issue) present information from a large Taiwan National Health Insurance Research Database study that links some Chinese herbal medicines with reduced risk of ESKD in patients with CKD.

Although in vitro and preclinical animal studies often indicate therapeutic benefits of Chinese herbal medicine in models of CKD, convincing evidence for or against Chinese herbal medicine for patients with CKD is limited. A summary of recent advances in traditional Chinese medicine for kidney disease in two publications by Zhong et al.^{4, 5} suggests that evidence is often limited by the small size and limited power of trials that are carried out. A clear limitation for advancing use of Chinese herbal medicines is the real need to increase our knowledge of the active ingredients and mechanism of action of the herbal medicines. More research is needed, something that is now occurring in China with recent increased research funding in the field of traditional medicines and an increasing need for alternative treatments for CKD patients.⁵ The report by Lin et al.³ is an exception to the small group studies. They used the Taiwan National Health Insurance Research Database to identify almost 25,000 stage 3–5 newly diagnosed CKD patients, who, after diagnosis, did or did not partake of a broad range of prescribed Chinese herbal medicines for CKD. The results should cause us to reflect on a resource of CKD therapies that is, still, often dismissed by Western medicine.