Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohammed First, Oujda, Morocco.
Public Hemodialysis Center, Ahfir, Morocco.
J Ethnopharmacol. 2022 Apr 24;288:114972. doi: 10.1016/j.jep.2022.114972. Epub 2022 Jan 4.
The consumption of nephrotoxic plants is quite frequent in Morocco and could explain the high prevalence of indeterminate nephropathy in patients with End-Stage Kidney Disease (ESKD).
to determine, in a population of chronic hemodialysis (CHD) patients and before the occurrence of ESKD, the prevalence of the use of nephrotoxic plants, in particular, Aristolochia longa L. (Bereztam) and the etiological role of plants in the rapid progression of known and unknown nephropathy toward the end stage of chronic hemodialysis.
This was a multicentric cross-sectional study spread over 12 months (May 2019-May 2020), carried out in public hemodialysis centers in the eastern region of Morocco. Clinical data were collected from medical records. Herbal and sociodemographic data were collected from a detailed and precise interview with each enrolled CHD patient.
A total of 404 CHD patients participated in the study. 71.5%, had used medicinal plants before the occurrence of ESKD and 32.9% had indeterminate nephropathy. Among the plants consumed, we identified plants whose kidney toxicity was well demonstrated, mainly Rhamnus alaternus L. (Mlilas) in 66.7%, Artemisia herba alba Asso (Chih) in 54.32%, Aristolochia longa L.(Bereztam) in 52.6%, and Rubia tinctorum L. (Fowa) in 47.4%. 27.7% of CHD patients had presented complications following the use of the plants before the occurrence of ESKD. In multivariate analysis, the use of plants to treat digestive disorders (OR 9.57; 95%CI [4.49-20.37], P < 0.001) and asthenia associated with anemia (OR 8.59; 95%CI [3.92-18.81], P < 0.001), as well as side effects observed after taking the plants (OR 4; 95%CI [1.09, 14.7], P = 0.03), were identified as significant risk factors for the occurrence of severe indeterminate nephropathy.
This study showed the high prevalence of consumption of nephrotoxic herbs which may be the root cause of chronic renal failure in CHD patients.
摩洛哥的肾毒性植物消费相当频繁，这可能解释了终末期肾病（ESKD）患者中不确定型肾病的高患病率。
在慢性血液透析（CHD）患者中，即在 ESKD 发生之前，确定肾毒性植物的使用情况，特别是马兜铃科植物马兜铃（Bereztam）和植物在已知和未知肾病向慢性血液透析终末期快速进展中的病因作用。
这是一项为期 12 个月（2019 年 5 月至 2020 年 5 月）的多中心横断面研究，在摩洛哥东部地区的公立血液透析中心进行。临床数据从病历中收集。草药和社会人口学数据是通过对每位纳入的 CHD 患者进行详细和准确的访谈收集的。
共有 404 名 CHD 患者参与了研究。71.5%的患者在发生 ESKD 之前使用过草药，32.9%的患者患有不确定型肾病。在所消耗的植物中，我们确定了一些肾毒性得到充分证明的植物，主要有 Rhamnus alaternus L.（Mlilas）66.7%，Artemisia herba alba Asso（Chih）54.32%，Aristolochia longa L.（Bereztam）52.6%和 Rubia tinctorum L.（Fowa）47.4%。27.7%的 CHD 患者在发生 ESKD 之前使用植物时出现并发症。多变量分析显示，使用植物治疗消化紊乱（OR 9.57；95%CI [4.49-20.37]，P<0.001）和与贫血相关的乏力（OR 8.59；95%CI [3.92-18.81]，P<0.001），以及服用植物后观察到的副作用（OR 4；95%CI [1.09, 14.7]，P=0.03），被确定为严重不确定型肾病发生的显著危险因素。
本研究表明，肾毒性草药的消费率很高，这可能是 CHD 患者慢性肾衰竭的根本原因。
