Utilization Pattern for Traditional Chinese Medicine among Late Stage Chronic Kidney Disease Patients: a Hospital-Based Cross-sectional Study

Abstract

In Taiwan, chronic kidney disease (CKD) is highly prevalent and traditional Chinese medicine (TCM) is one of the most commonly used complementary medicines. To date, little information is available on the utilization patterns for TCM among CKD patients, particularly those with late stage CKD. We conducted a cross-sectional hospital-based study to investigate this issue. In this study, late stage CKD patients were identified by ICD-9-CM codes: 585 and 586, and only CKD stage 3b, 4 and 5 patients were included in the analysis. Clinical information was retrieved from the electronic medical records database from January, 1,2006 to December, 31, 2011. Among a total of 8,459 patients, 408 TCM users and 8,051 non-TCM users were identified and their data were analyzed. We found that TCM users were almost four times more likely to be older than 55 years than non-TCM users, after controlling for the other covariates (adjusted odds ratio [aOR]: 3.98, 5% confidence interval [CI]: [2.33,6.81]). They were also less likely to have diabetes (aOR: 0.48), hypertension (aOR: 0.62) or gout (aOR: 0.62). Among all disease conditions, late stage CKD patients with neoplasms had the highest tendency to seek TCM treatment compared to non-neoplasm CKD patients (aOR: 5.39, 95% CI: [4.64, 6.26]). Among all TCM users, internal medicine outpatient services (providing CHMs only) is more frequently used than acupuncture/massage outpatient services (3,476 vs. 320 visits). Jia-Wei-Xiao-Yao-San (JWXYS) was the most commonly prescribed Chinese herbal medicine (CHM) for late CKD patients (36.2% of 4,494 prescriptions), followed by Bu-Yang-Huan-Wu-Tang (BYHWT) (33.1%). This is the first study to identify the characteristics of TCM users among late stage CKD patients and further research targeting the safety and efficacy of the most commonly used CHMs is needed.