Effectiveness of Chinese herbal medicine combined with Western medicine on deferring dialysis initiation for nondialysis chronic kidney disease stage 5 patients: a multicenter prospective nonrandomized controlled study.

Yifan Wu,Yu Peng,Peiqing Zhang,Yuan Xu,Jianmin Li,Lei Zhang,Zhaoyu Lu,Fang Tang,Peng Xu,Wei Shi,Xusheng Liu,Chuan Zou,Hui Liu,Dajun Yu,Min Zhang,Ming Chen,Xindong Qin,Niansong Wang,Wei Sun,Junzhou Fu,La Zhang,Wenge Li,Kun Bao,Yiping Wang,Feng Li,Jihong Zhan,Heng Weng,Yongli Zhan,Guobin Su,Lizhe Fu,Hongfei Pei,Fuhua Lu,Lihong Yang,Yuning Liu,Lixin Wang,Lanfen Meng,Xinfeng Guo,Hongtao Yang,Chuang Li,Lili Deng,Xina Jie,Jinghong Zhao,Wei Mao,Xiaoqin Wang,Dingkun Gui,Zehuai Wen,Daixin Zhao,Ping Li,Hongyu Chen,Hongyan Li,Aihua Ou,Jingai Fang ,Lichang Liu ,Yan Xie ,Huilian Hou ,Ying Lü ,Zhiyao He ,Yuping Huang ,Ning Yang ,Wei Ouyang ,Yulin Deng ,Lianbo Wei ,Dianqing Xu ,Limei Song ,Xin Cheng ,Qian Lin

doi:10.21037/atm-21-871

Abstract

BackgroundIn clinical practice, Chinese herbal medicine (CHM) purportedly has beneficial therapeutic effects for chronic kidney disease (CKD), which include delaying disease progression and dialysis initiation. However, there is a lack of high-quality evidence-based results to support this. Therefore, this study aimed to evaluate the efficacy of CHM combined with Western medicine in the treatment of stage 5 CKD.MethodsThis was a prospective nonrandomized controlled study. Stage 5 CKD (nondialysis) patients were recruited form 29 AAA class hospitals across China from July 2014 to April 2019. According to doctors’ advice and the patients’ wishes, patients were assigned to the CHM group (Western medicine + CHM) and the non-CHM group (Western medicine). Patient demographic data, primary disease, blood pressure, Chinese and Western medical drugs, clinical test results, and time of dialysis initiation were collected during follow-up.ResultsA total of 908 patients were recruited in this study, and 814 patients were finally included for further analysis, including 747 patients in the CHM group and 67 patients in the non-CHM group. 482 patients in the CHM group and 52 patients in the non-CHM group initiated dialysis. The median time of initiating dialysis was 9 (7.90, 10.10) and 3 (0.98,5.02) months in the CHM group and non-CHM group, respectively. The multivariate Cox regression analysis showed that patients in the CHM group had a significantly lower risk of dialysis [adjusted hazard ratio (aHR): 0.38; 95% confidence interval (CI): 0.28, 0.53] compared to those in the non-CHM group. After 1:2 matching, the outcomes of 160 patients were analyzed. The multivariate Cox regression analysis showed that patients in the CHM group had a significantly lower risk of dialysis (aHR: 0.32; 95% CI: 0.21, 0.48) compared to patients in the non-CHM group. Also, the Kaplan-Meier analysis demonstrated that the cumulative incidence of dialysis in the CHM group was significantly lower than that in the non-CHM group (log-rank test, P<0.001) before and after matching.ConclusionsThis study suggest that the combination of CHM and Western medicine could effectively reduce the incidence of dialysis and delay the time of dialysis initiation in stage 5 CKD patients.

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