Abstract
Objective: Harmonizing formulas are associated with beneficial renal outcomes in chronic kidney disease (CKD), but the therapeutic mechanisms are unclear. The study aims to explore the associations of intentions and independent factors with harmonizing formulas prescriptions for patients with CKD. Methods: We conducted a population-based cross-sectional study to explore factors associated with harmonizing formulas prescription. Patients who had been prescribed harmonizing formulas after CKD diagnosis was defined as the using harmonizing formulas group. Disease diagnoses when having harmonizing formula prescriptions and patient characteristics related to these prescriptions were collected. Results: In total, 24,971 patients were enrolled in this analysis, and 5,237 (21%) patients were prescribed harmonizing formulas after CKD diagnosis. The three most frequent systematic diseases and related health problems for which harmonizing formula prescriptions were issued in CKD were symptoms, signs, and ill-defined conditions (24.5%), diseases of the digestive system (20.67%), and diseases of the musculoskeletal system (12.9%). Higher likelihoods of harmonizing formula prescriptions were associated with young age (adjusted odds ratio: 0.98, 95% confidence interval: 0.97–0.98), female sex (1.79, 1.68–1.91), no diabetes (1.20, 1.06–1.36), no hypertension (1.38, 1.27–1.50), no cerebrovascular disease (1.34, 1.14–1.56), less disease severity (0.85, 0.83–0.88), using nonsteroidal anti-inflammatory drugs (NSAIDs) (1.65, 1.54–1.78), and using analgesic drugs other than NSAIDs (1.47, 1.35–1.59). Conclusion: Harmonizing formulas are commonly used for treating symptoms of the digestive and musculoskeletal systems in CKD cases. Further research on harmonizing formula effectiveness with regard to particular characteristics of CKD patients is warranted.
Highlights
Chronic kidney disease (CKD), defined as substantial renal damage persisting for three months, is prevalent and affects 8–16% of adults globally (Jha et al, 2013)
Our study explored disease categories for which harmonizing formulas were prescribed and independent factors associated with harmonizing formula prescriptions in patients with CKD
Patients who were young; female (1.79, 1.68–1.91); had high insurance amounts; lived in central Taiwan (1.26, 1.16–1.37), southern Taiwan (1.20, 1.11–1.30), or urban areas (1.17, 1.07–1.26); did not have diabetes (1.20, 1.06–1.36), hypertension (1.38, 1.27–1.50), or cerebrovascular disease (1.34, 1.14–1.56); had lower disease severity (0.85, 0.83–0.88); used nonsteroidal anti-inflammatory drugs (NSAIDs) (1.65, 1.54–1.78); and used analgesic drugs other than NSAIDs (1.47, 1.35–1.59) were more likely to have harmonizing formula prescriptions
Summary
Chronic kidney disease (CKD), defined as substantial renal damage persisting for three months, is prevalent and affects 8–16% of adults globally (Jha et al, 2013). After a patient develops CKD, the renal function might progressively deteriorate over several years until reaching end-stage renal disease (ESRD) (Zhong et al, 2017). Guidelines have recommended that CKD should be appropriately managed to slow its progression (Levey et al, 2002; Levin et al, 2013), maintaining stable renal function and relieving the symptoms and signs caused by accumulation of uremic toxins remain challenging. Chinese herbal medicines (CHMs), through syndrome differentiation and treatment selection, present a means to improve CKD care and may stabilize renal function. Improving syndromes by treatment is the main philosophy of CHMs (Jiang et al, 2012). After differentiating syndromes from one patient, a physician would prescribe natural products following the principle of chief-deputy-assistantenvoy. The chief herb product within one prescription provides the main therapeutic effect for syndromes (Su et al, 2016)
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