Abstract
Hypertensive nephropathy is a common complication of hypertension. Traditional Chinese medicine has been used in the clinical treatment of hypertensive nephropathy for a long time, but the commonly used prescriptions have not been summarized, and the basic therapeutic approaches have not been discussed. Based on data from 3 years of electronic medical records of traditional Chinese medicine used at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, a complex network and machine learning algorithm was used to explore the prescribed herbs of traditional Chinese medicine in the treatment of hypertensive nephropathy (HN). In this study, complex network algorithms were used to describe traditional Chinese medicine prescriptions for HN treatment. The Apriori algorithm was used to analyze the compatibility of these treatments with modern medicine. Data on the targets and regulatory genes related to hypertensive nephropathy and the herbs that affect their expression were obtained from public databases, and then, the signaling pathways enriched with these genes were identified on the basis of their participation in biological processes. A clustering algorithm was used to analyze the therapeutic pathways at multiple levels. A total of 1499 prescriptions of traditional Chinese medicines used for the treatment of hypertensive renal damage were identified. Fourteen herbs used to treat hypertensive nephropathy act through different biological pathways: huangqi, danshen, dangshen, fuling, baizhu, danggui, chenpi, banxia, gancao, qumai, cheqianzi, ezhu, qianshi, and niuxi. We found the formulae of these herbs and observed that they could downregulate the expression of inflammatory cytokines such as TNF, IL1B, and IL6 and the NF-κB and MAPK signaling pathways to reduce the renal inflammatory damage caused by excessive activation of RAAS. In addition, these herbs could facilitate the deceleration in the decline of renal function and relieve the symptoms of hypertensive nephropathy. In this study, the traditional Chinese medicine approach for treating hypertensive renal damage is summarized and effective treatment prescriptions were identified and analyzed. Data mining technology provided a feasible method for the collation and extraction of traditional Chinese medicine prescription data and provided an objective and reliable tool for use in determining the TCM treatments of hypertensive nephropathy.
Highlights
hypertensive nephropathy (HN) caused by hypertension commonly damages the kidneys [1]. e International Cross-Sectional Study [2] of Chronic Kidney Disease (CKD) published by the International Society of Nephrology Kidney Disease Data Center (ISNKDDC) in 2016 showed that hypertension significantly increases the prevalence of CKD (corrected odds ratio (OR) 1.68, 95% confidence interval (CI) 1.60–1.76). e blood pressure control goal of HN remains the focus of discussions
Data from randomized controlled trials showed that lowering blood pressure while inhibiting renin-angiotensin-aldosterone system (RAAS) reduced the severity of proteinuria, showing an additional benefit compared with only a reduction in blood pressure in patients with advanced nephropathy and albuminuria with albumin excretion levels greater than 33.9 mg/mmol [9]
We selected 1449 prescriptions of traditional Chinese medicine from the electronic medical records (EMRs) data of 2055 patients with HN, and these prescriptions included 425 herbs used 35734 times, and each prescription contained, on average, 23.84 ± 3.88 herbs. e core traditional Chinese medicines used in the treatment prescriptions for HN were obtained by hierarchical extraction algorithm: Radix Astragali, Radix Salviae liguliobae, Radix Codonopsis pilosulae, Poria, Rhizoma Atractylodis macrocephalae, Radix Angelicae sinensis, Pericarpium Citri Reticulatae, Rhizoma Pinelliae, and Radix Glycyrrhizae
Summary
HN caused by hypertension commonly damages the kidneys [1]. e International Cross-Sectional Study [2] of Chronic Kidney Disease (CKD) published by the International Society of Nephrology Kidney Disease Data Center (ISNKDDC) in 2016 showed that hypertension significantly increases the prevalence of CKD (corrected odds ratio (OR) 1.68, 95% confidence interval (CI) 1.60–1.76). e blood pressure control goal of HN remains the focus of discussions. E African-American Study of Kidney Disease and Hypertension (AASK) showed that lower blood pressure targets do not confer greater benefit than conventional 140/90 mmHg targets. E Modification of Diet in Renal Disease Study (MDRD) did not address the end point of deterioration of renal function, such as ESRD, and there was a difference in the proportion of angiotensin-converting-enzyme (ACE) inhibitor use between the lower blood pressure group and the usual care group of patients, which limited the observations of the results [5]. Data from randomized controlled trials showed that lowering blood pressure while inhibiting renin-angiotensin-aldosterone system (RAAS) reduced the severity of proteinuria, showing an additional benefit compared with only a reduction in blood pressure in patients with advanced nephropathy and albuminuria with albumin excretion levels greater than 33.9 mg/mmol [9]. An increase in proteinuria was significantly associated with poor cardiovascular and renal outcomes (adjusted hazard ratio (HR) 1.40, 95% CI 1.11–1.78) [10]
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