Effectiveness of Integrative Chinese-Western Medicine for Chronic Kidney Disease and Diabetes: A Retrospective Cohort Study

Kam Wa Chan, Tak Yee Chow, Kam Yan Yu, Yibin Feng, Lixing Lao, Zhaoxiang Bian, Vivian Taam Wong*, Sydney Chi Wai Tang*

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

11 Citations (Scopus)

Abstract

Diabetes and chronic kidney disease (CKD) are pandemic, requiring more therapeutic options. This retrospective cohort evaluated the effectiveness, safety profile and prescription pattern of a pilot integrative medicine service program in Hong Kong. Data from 38 patients with diabetes and CKD enrolled to receive 48-week individualized add-on Chinese medicine (CM) were retrieved from the electronically linked hospital database. A 1:1 cohort was generated with patients from the same source and matched by propensity score. The primary outcomes are the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance and mixed regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The rate of adverse events and the change of key biochemical parameters were analyzed. After a median of 51 weeks, patients who received add-on CM had stabilized eGFR (difference in treatment period: 0.74 ml/min/1.73m2, 95% CI: -1.01 to 2.50) and UACR (proportional difference in treatment period: 0.95, 95% CI: 0.67 to 1.34). Add-on CM was associated with significantly preserved eGFR (Inter-group difference: 3.19 ml/min/1.73m2, 95%CI: 0.32 to 6.06, p = 0.030) compared to standard care. The intergroup ratio of UACR was comparable (0.70, 95% CI: 0.45 to 1.08, p = 0.104). The result is robust in sensitivity analysis with different statistical methods, and there was no interaction with CKD stage and UACR. The rate of serious adverse events (8.1% vs. 18.9%, p = 0.174), moderate to severe hyperkalemia (8.1% vs. 2.7%, p = 0.304) and hypoglycemia (13.5% vs. 5.4%, p = 0.223), and the levels of key biochemical parameters were comparable between groups. The top seven most used CMs contained two classical formulations, namely Liu-wei-di-huang-wan and Si-jun-zi-tang. Individualized add-on CM was associated with significant kidney function preservation and was well tolerated. Further randomized controlled trials using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang are warranted.

Original languageEnglish
Pages (from-to)371-388
Number of pages18
JournalThe American Journal of Chinese Medicine
Volume50
Issue number2
DOIs
Publication statusPublished - 7 Feb 2022

Scopus Subject Areas

  • Medicine(all)
  • Complementary and alternative medicine
  • Endocrinology, Diabetes and Metabolism
  • Nephrology
  • Epidemiology
  • Public Health, Environmental and Occupational Health

User-Defined Keywords

  • Chronic Kidney Disease
  • Diabetes
  • Diabetic Kidney Disease
  • Effectiveness
  • Glomerular Filtration Rate
  • Integrative Medicine
  • Rehmannia
  • Traditional Chinese Medicine

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