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Poudarjeno: pacienti z diagnozo kronične ledvične bolezni, ki so prejeli predpisana kitajska zelišča brez aristolohične kisline še pred začetkom zdravljenja z eritropoietinom, so imeli manjše tveganje za smrt kot tisti, ki tega niso bili deležni.
Kronična ledvična bolezen (KLB) je običajna kronična bolezen z oceno globalne statisitke v pojavu med 8-16 % prebivalstva. KLB je prav tako eden izmed glavnih razlogov, ki prispevajo k zvišanju svetovne statistike smrtnosti. Najvišja pogostost pojava KLB ter končne ledvične odpovedi (KLO) je statistično zabeležena na Tajvanu kjer je tudi raba kitajske zeliščne medicine (KZM) zelo priljubljena. Prejšnje raziskave so pokazale, da so kitajske zeliščne mešanice, ki vsebujejo aristoholična kislino (AK) za ljudi kancerogeno substanco, povezane z akutno odpovedjo ledvic in karcinomom sečil. Raziskava velikega obsega preiskovanih ljudi je prav tako pokazala, da je uživanje katerikolih zdravil KZM povezano s pojavom KLB na Tajvanu. Kakorkoli, v nedavno objavljeni študiji primer-kontrola so rezultati pokazali, da je pojav KLB bil znatno manjši pri pacientih, ki so prejeli predpisana zdravila KZM, ne pa pri pacientih, ki so uživali nepredpisana KZM zdravila. Še več, nekatera izmed splošno predpisanih zdravil KZM, kot so Astragalus membranaceus (huang qi), Angelica sinensis (dong quai) in Rheum palmatum (da huang, rabarbarina korenina) so pokazala, da posedujejo zaščitne učinke ledvičnega tkiva.
V celoti je v raziskavi na Tajvanu med letom 2000 in 2008 sodelovalo 13 864 ljud. Opažen trend med različnimi skupinami s predpisanimi zdravili brez aristolohične kisline je bil statistično precejšnejši. Odkritja raziskave so v nadaljnjem še pokazale, da je bila za skupino z zdravili KZM na recept brez aristolohične kisline pred diagnozo s KLB stopnja preživetja znano višja kot za tiste, ki zdravil nikoli niso prejeli ali tiste, katerim so bila predpisana KZM zdravila brez aristoholične kisline samo pred diagnozo KLB (p<0,001).
V primerjavi s sodelujočimi brez KLB sta bila pojav kardiovaskularnih dogodkov in tveganje za smrtnost višja med pacienti s KLB. Zato je indentifikacija možnih zdravljenj, ki lahko zaustavijo napredovanje KLB, pomembna pri preventivi visoke smrtnosti med pacienti s KLB.
Na Tajvanu, v skladu z enotnimi formulami KZM, ki jih zagotavljajo tajvanski izvajalci KZM, je večina predpisanih zelišč KZM sestavljenih formul. KZM formule pogosto vsebujejo sestavine KZM, ki na ledvice delujejo zaščitno, kot so Astragalus membranaceus, Angelica sinensis in Rheum palmatum. Za ta KZM zdravila so odkrili, da inhibirajo ledvično tubulointersticijsko fibrozo, zvišajo proizvajanje dušikovega oksida in ublažijo ledvično intersticijsko fibrozo ter nižje vrednosti serumskega holesterola, dušika v krvi in sečnini, kreatinina, oksidativnega stresa in profibrotičnih dejavnikov, kar zmanjšuje nefritis in ledvično nekrozo.
Vir: 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 https://bmjopen.bmj.com/content/4/2/e004033
Better survival rate in Chronic kidney disease patients with Chinese herbal medicine prescription
Highlight: Patients who received non-aristolochic acid prescribed Chinese Herbal Medicine after the diagnosis of Chronic Kidney Disease, yet before the start of erythropoietin therapy had a lower risk of mortality than those who did not..
Chronic kidney disease (CKD) is a common chronic disease with an estimated global prevalence of approximately 8–16%. CKD is also one of the main causes that contribute to the increasing mortality rate around the world. Taiwan has the highest incidence of CKD and end-stage renal disease (ESRD) worldwide and the use of Chinese herbal medicines (CHMs) is very popular in Taiwan. Previous studies had found that CHMs containing aristolochic acid (AA), a carcinogenic substance to human beings, were correlated with acute renal failure and urinary tract carcinoma. A large population-based study had also shown that the intake of any kinds of CHM was associated with the occurrence of CKD in Taiwan. However, in a recently published case–control study, the occurrence of CKD was found to be limited to participants who received non-prescribed CHMs, but not those who consumed prescribed CHMs. Moreover, some commonly prescribed CHMs such as Astragalus membranaceus (huang qi), Angelica sinensis (dong quai) and Rheum palmatum (da huang, rhubarb root) were suggested to possess renoprotective (protect kidney) effects.
A total of 13 864 participants were included in the study in Taiwan between year 2000 and 2008. The observed trend between different groups of non-AA prescribed CHMs use was statistically significant. The study findings further indicated that receipt of non-AA prescribed CHMs after the diagnosis of CKD, with or without the use of non-AA prescribed CHMs before CKD diagnosis, had a significantly better survival rate than those who never received or those who received non-AA prescribed CHMs only before the diagnosis of CKD (p<0.001; figure 1).
Compared with participants without CKD, the occurrence of cardiovascular events and the risk of mortality were higher among patients with CKD. Therefore, identifying possible treatments that can delay the progression of CKD is important in the prevention of mortality among patients with CKD.
In Taiwan, according to the unified formulas of CHMs provided by the Taiwanese Chinese Medicine Practitioner, the majority of prescribed CHMs are compound (cocktail) formulas. The CHM formulas often contain ‘renoprotective’ CHM ingredients such as Astragalus membranaceus, Angelica sinensis and Rheum palmatum. These CHMs were found to inhibit renal tubulointerstitial fibrosis, enhance nitric oxide production and alleviate renal interstitial fibrosis, and lower serum cholesterol, blood urea nitrogen, creatinine, oxidative stress and profibrotic factors to attenuate nephritis and renal necrosis.
Reference: 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 https://bmjopen.bmj.com/content/4/2/e004033
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