四种中药可在不增加高钾血症风险的情况下为晚期慢性肾脏病患者提供肾保护和生存获益：一项全国性队列研究。
Four prescribed Chinese herbal medicines provide renoprotection and survival benefit without hyperkalemia risk in patients with advanced chronic kidney disease: A nationwide cohort study.
机构信息
Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, No. 2, Minsheng Rd., Chiayi, Dalin 622, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan,.
Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
出版信息
Phytomedicine. 2022 Jan;95:153873. doi: 10.1016/j.phymed.2021.153873. Epub 2021 Dec 3.
BACKGROUND
Chinese herbal medicine (CHM) has been used as adjuvant treatment of chronic kidney disease (CKD) for years. Astragalus membranaceus (A. membranaceus, Huangqi [A]), Angelica sinensis (Oliv.) Diels (Danggui [S]), Rheum palmatum L. (Dahuang [R]), and Salvia miltiorrhiza Bunge (Danshen [D]) are considered as potentially renoprotective CHMs. However, there is limited evidence on whether ASRD use affects outcomes and causes hyperkalemia in patients with stage 4 and stage 5 advanced CKD.
PURPOSE
To investigate between ASRD use (vs. nonuse) and risks of end-stage renal disease (ESRD), death, and hyperkalemia in patients with advanced CKD.
STUDY DESIGN
Retrospective nationwide cohort study using claims data from the Taiwan's 2005 Longitudinal Generation Tracking Database in 2000-2016.
METHODS
A total of 24,572 patients with advanced CKD were identified and 15,729 eligible patients were enrolled in the propensity score matching, with 1,401 incident ASRD users (8.9%) and 14,328 nonusers (91.1%). Finally, 1,076 ASRD users and 4,304 matched nonusers were subjected to analysis. We used Cox proportional hazards regression model to estimate the hazard ratios for ESRD and death and Poisson regression to estimate incidence rate ratio of hyperkalemia. The additive effect of one to four ASRD and the pooling effect of individual ASRD on risks of ESRD and death were also addressed.
RESULTS
In a total follow-up of 15,740 person-years, 2,703 patients (50.2%) developed ESRD and 499 (9.3%) died before progression to ESRD. As compared with nonusers, ASRD users were associated with adjusted hazard ratios of 0.83 (95% confidence interval, 0.76-0.91) for ESRD and 0.78 (0.30-0.93) for death, as well as adjusted incidence rate ratios of 0.54 (0.48-0.60) for inpatient hyperkalemia and 0.44 (0.42-0.46) for total hyperkalemia. The renal and survival benefits of ASRD use were consistent across almost patient subgroups on multivariate stratified analyses. Using all four ASRD provided the lowest risks of ESRD (0.30; 0.71-0.52) and death (0.32; 0.17-0.63). Individual use of ASRD also demonstrated comparable renal and survival benefits.
CONCLUSION
ASRD use was associated with lower risks of ESRD and death among advanced CKD patients. This benefit did not increase hyperkalemia risk.
背景
中药（CHM）已被用作慢性肾脏病（CKD）的辅助治疗多年。黄芪（A. membranaceus，Huangqi[A]）、当归（Oliv.）Diels（Danggui[S]）、大黄（Rheum palmatum L.，Dahuang[R]）和丹参（Salvia miltiorrhiza Bunge，Danshen[D]）被认为是具有潜在肾保护作用的 CHM。然而，关于 ASRD 使用是否会影响 4 期和 5 期晚期 CKD 患者的结局并导致高钾血症，证据有限。
目的
调查 ASRD 使用（vs. 未使用）与晚期 CKD 患者发生终末期肾病（ESRD）、死亡和高钾血症的风险之间的关系。
研究设计
利用台湾 2005 年纵向世代追踪数据库在 2000-2016 年的索赔数据进行回顾性全国队列研究。
方法
共确定了 24572 名晚期 CKD 患者，并在倾向评分匹配中纳入了 15729 名合格患者，其中有 1401 例新发 ASRD 用户（8.9%）和 14328 名未使用者（91.1%）。最终，有 1076 名 ASRD 用户和 4304 名匹配的未使用者接受了分析。我们使用 Cox 比例风险回归模型估计 ESRD 和死亡的风险比，并使用泊松回归估计高钾血症的发病率比值。还探讨了 ASRD 数量从 1 到 4 的附加效应和个体 ASRD 的汇总效应对 ESRD 和死亡风险的影响。
结果
在总计 15740 人年的随访中，2703 名患者（50.2%）发生 ESRD，499 名（9.3%）在进展为 ESRD 之前死亡。与未使用者相比，ASRD 用户的 ESRD 风险调整后的风险比为 0.83（95%置信区间，0.76-0.91），死亡风险调整后的风险比为 0.78（0.30-0.93），住院高钾血症的风险调整后发病率比值为 0.54（0.48-0.60），总高钾血症的风险调整后发病率比值为 0.44（0.42-0.46）。在多变量分层分析中，ASRD 使用的肾和生存获益在几乎所有患者亚组中均一致。使用全部四种 ASRD 可使 ESRD（0.30；0.71-0.52）和死亡（0.32；0.17-0.63）的风险最低。个体使用 ASRD 也表现出可比的肾脏和生存获益。
结论
ASRD 使用与晚期 CKD 患者的 ESRD 和死亡风险降低相关。这种益处并未增加高钾血症的风险。
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