RT Journal Article
SR Electronic
T1 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
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e004033
DO 10.1136/bmjopen-2013-004033
VO 4
IS 2
A1 Hsieh, Chuan Fa
A1 Huang, Song Lih
A1 Chen, Chien Lung
A1 Chen, Wei Ta
A1 Chang, Huan Cheng
A1 Yang, Chen Chang
YR 2014
UL http://bmjopen.bmj.com/content/4/2/e004033.abstract
AB Objectives To evaluate the relationship between the use of non-aristolochic acid (AA) prescribed Chinese herbal medicines (CHMs) and the risk of mortality in patients with chronic kidney disease (CKD). Design Nationwide population-based follow-up study. Setting Longitudinal health insurance database sampled from the Taiwan National Health Insurance Research Database. Participants A total of 47 876 patients with CKD were identified. Participants who had ever used AA-containing CHMs, had cancer or HIV prior to the diagnosis of CKD, died within the first month of CKD diagnosis and who were not Taiwanese citizens were excluded. A total of 13 864 participants were eligible for final analysis. Primary and secondary outcome measures All-cause mortality among patients with CKD between 2000 and 2008. Results After controlling for potential confounders, we found that participants who started to receive non-AA prescribed CHMs after the diagnosis of CKD had a lower risk of mortality as compared with non-users of non-AA prescribed CHMs (adjusted HR (aHR) 0.6; 95% CI 0.4 to 0.7, p<0.001). Moreover, participants who had used non-AA prescribed CHMs prior to and after the diagnosis of CKD also had a lower risk of mortality than non-users (aHR 0.6; 95% CI 0.5 to 0.8, p<0.001). In subgroup analyses, we found that such an inverse association was present only among patients who were not eligible to receive erythropoietin therapy (ie, serum creatinine ≦6 mg/dL and/or haematocrit value ≧28%). Conclusions Patients who received non-AA prescribed CHMs after the diagnosis of CKD, yet before the start of erythropoietin therapy had a lower risk of mortality than those who did not.