Original Investigation
Pathogenesis and Treatment of Kidney Disease
Herbal Therapy Is Associated With the Risk of CKD in Adults Not Using Analgesics in Taiwan

https://doi.org/10.1053/j.ajkd.2007.02.259Get rights and content

Background

Taiwan has the greatest incidence rate of end-stage renal disease in the world. Several cases of Chinese herb nephropathy were reported in Taiwan. Therefore, we studied the association between herbal therapy and chronic kidney disease (CKD) in Taiwan.

Study Design

Cross-sectional survey.

Setting & Participants

1,740 adults in the Nutrition and Health Survey in Taiwan (1993 to 1996).

Predictor

Herbal and analgesic therapy.

Outcomes & Measurements

CKD after adjustment for potential confounding variables.

Results

Among medication users, prevalences of herbal therapy and analgesic use were 21.6% and 13.2%, respectively. The prevalence of CKD was 9.9%. Participants with CKD were older and had more analgesic use, diabetes, hypertension, and cardiovascular disease. Analgesic use was associated independently and positively with CKD (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5; P = 0.003) and CKD stage (odds ratio, 2.3; 95% confidence interval, 1.4 to 3.6; P = 0.003). Conversely, herbal therapy was associated independently and positively with CKD (odds ratio, 1.39; 95% confidence interval, 1.2 to 1.7; P = 0.002) and CKD stage (odds ratio, 1.38; 95% confidence interval, 1.1 to 1.7; P = 0.004) only in participants who did not use analgesics.

Limitations

Because this was a cross-sectional study, cause and effect could not be ascertained.

Conclusions

Herbal therapy was associated with CKD in adults in Taiwan who did not use analgesics.

Section snippets

Study Population

NAHSIT was a complex survey with stratified multistage probability sampling.12, 13 Details of the study procedure were described in our previous study.14 Briefly, Taiwan (with ∼21 million inhabitants in 1993 to 1996) was stratified into 7 strata, and in each stratum, 3 townships were selected with the selection probability proportional to the population size of the township. Among the 7 strata, there were 9 cities (population ≥ 100,000) and 12 rural areas (population < 100,000). A total of

Demographic Characteristics by Participation

The participation rate was 52.9% (1,740 of 3,292). As listed in Table 1, there was a significantly smaller proportion of men in participants than nonparticipants. Thus, men and women were analyzed separately when there were significant interactions between sex and herbal therapy. Conversely, there were no significant differences in residence area (city versus rural area), age, smoking (pack-years), alcohol drinking (drink-years), herbal therapy, analgesic use, known hypertension, known DM, and

Discussion

This is the first demonstration on a population basis that herbal therapy is associated independently with CKD in adults who were not using analgesics. Moreover, the prevalence of CKD was as high as 9.9% in Taiwan. These findings have important epidemiological implications because Taiwan is number 1 in the world in the incidence of ESRD.3

Some of the major CKD risk factors were confirmed, whereas others were not confirmed in univariate analysis in this study. However, multivariate analyses are

Acknowledgement

NAHSIT was carried out by the Institute of Biomedical Sciences of Academia Sinica and Department of Biochemistry, College of Medicine of National Taiwan University, directed by Dr Wen-Harn Pan and Dr Po-Chao Huang. The Office of Survey Research of Academia Sinica is responsible for data distribution. The assistance provided by the institutes and aforementioned individuals is greatly appreciated. The views expressed herein are solely those of the authors.

References (50)

  • J. Coresh et al.

    Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey

    Am J Kidney Dis

    (2003)
  • G. Fitzmaurice

    The meaning and interpretation of interaction

    Nutrition

    (2000)
  • L.C. Hwang et al.

    Prevalence of obesity and metabolic syndrome in Taiwan

    J Formos Med Assoc

    (2006)
  • P.K. Li et al.

    Prevalence of silent kidney disease in Hong Kong: The screening for Hong Kong Asymptomatic Renal Population and Evaluation (SHARE) program

    Kidney Int Suppl 94

    (2005)
  • C. Isnard Bagnis et al.

    Herbs and the kidney

    Am J Kidney Dis

    (2004)
  • C.R. Colson et al.

    Kidney injury from alternative medicines

    Adv Chronic Kidney Dis

    (2005)
  • G.S. Markowitz et al.

    Drug-induced renal failure: A focus on tubulointerstitial disease

    Clin Chim Acta

    (2005)
  • J.H. Wirth et al.

    Use of herbal therapies to relieve pain: A review of efficacy and adverse effects

    Pain Manag Nurs

    (2005)
  • S.H. Liou et al.

    Blood lead levels in Taiwanese adults: Distribution and influencing factors

    Sci Total Environ

    (1996)
  • J.L. Vanherweghem et al.

    Rapidly progressive interstitial renal fibrosis in young women: Association with slimming regimen including Chinese herbs

    Lancet

    (1993)
  • T.P. Shakespeare et al.

    Improving interpretation of clinical studies by use of confidence levels, clinical significance curves, and risk-benefit contours

    Lancet

    (2001)
  • USRDS 2005 Annual Data Report: International comparisons

    Am J Kidney Dis

    (2006)
  • C.T. Liu

    Health care systems in transitionII. Taiwan, Part I. A general overview of the health care system in Taiwan

    J Public Health Med

    (1998)
  • K. Kaphle et al.

    Herbal medicine research in Taiwan

    Evid Based Complement Alternat Med

    (2006)
  • H.Y. Yang et al.

    Aristolochic acid-related nephropathy associated with the popular Chinese herb Xi Xin

    J Nephrol

    (2006)
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    Originally published online as doi:10.1053/j.ajkd.2007.02.259 on March 27, 2007.

    Support: This study was supported by grant no. DOH93-TD-D-113-021(2) from the Department of Health, Taiwan. Data analyzed in this article were collected by the research project Nutrition and Health Survey in Taiwan (NAHSIT) sponsored by the Department of Health in Taiwan (DOH FN8202, DOH-83-FS-41, DOH-84-FS-11, DOH-85-FS-11, DOH-86-FS-11). Potential conflicts of interest: None.

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