Effect of Chinese herbal enema prescription on renal function, enterogenous uremic toxins and intestinal barrier function in stage 3 to 5 chronic kidney disease predialysis participants: A randomized controlled trial.

BACKGROUND

This study investigates the efficacy and mechanism of a Chinese herbal enema prescription (CHEP) in improving renal function and delaying progression to dialysis in patients with chronic kidney disease (stage 3-5) before dialysis.

METHODS

A total of 102 patients (mean age: 47.6 ± 12.3 years; male: 46.15%) satisfying the inclusion criteria were randomized into control or experimental groups. Patients in the experimental group received retention enema using CHEP in addition to standard Western medical treatment, whereas patients in the control group only received standard Western medical treatment, 2-week intervention period. Changes in traditional Chinese medicine (TCM) symptom scores (a composite score based on the severity and frequency of TCM-defined symptoms such as fatigue, anorexia, and edema), renal function (serum creatinine [SCr], uric acid, blood urea nitrogen, microinflammatory C-reactive protein [CRP]), enterogenous uremic toxins (trimethylamine oxide [TMAO], indoxyl sulfate), and intestinal barrier function (endotoxin [ET], d-Lactate [DL], and diamine oxidase [DAO]) before and after treatment in both groups were compared.

RESULTS

After treatment, the TCM symptom scores of both groups decreased compared to those before treatment. Moreover, the difference in the scores of the experimental group pre- versus post- treatment was significantly greater than that of the control group (standardized mean difference [SMD] = -1.79, 95% confidence interval [CI] = -2.56 to 1.02) (P < .01).The total effective rate based on TCM symptom improvement was 73.3% in the control group and 91.3% in the experimental group (odds ratio = 2.34, 95% CI = 1.56-4.28) (P < .05). Concentrations of SCr and blood urea nitrogen were significantly lower (P < .05) in CHEP versus control at the end of treatment; however, there were no significant differences in uric acid, estimated glomerular filtration rate (eGFR), and CRP (P > .05). The levels of DL (SMD = 84.11, 95% CI = 10.65-162.21), DAO (SMD = 14.08, 95% CI = 2.33-27.41), and ET (SMD = 37.27, 95% CI = 9.31-65.50) in the experimental group after treatment showed significant differences (P < .05). The indoxyl sulfate (SMD [95%] CI = 16.11 [1.22-33.11]) and TMAO (SMD [95%] CI = 8.13 (1.26-15.86)] in the experimental group after treatment were significantly lower compared to the control group (P < .05).

CONCLUSION

CHEP can enhance the clinical function and delay the decline of kidney function in patients with chronic kidney disease (stage 3-5), mainly by promoting the excretion of enterogenic uremic toxins and improving intestinal barrier function to delay renal function progression.