Therapeutic Use of Traditional Chinese Herbal Medications for Chronic Kidney Diseases

Yifei Zhong; Yueyi Deng; Yiping Chen; Peter Y. Chuang; John Cijiang He

Disclosures

Kidney Int. 2013;84(6):1108-1118. 

In This Article

Abstract and Introduction

Abstract

Traditional Chinese herbal medications (TCHMs) are frequently used in conjunction with western pharmacotherapy for treatment of chronic kidney diseases (CKD) in China and many other Asian countries. The practice of traditional Chinese medicine is guided by cumulative empiric experience. Recent in vitro and animal studies have confirmed the biological activity and therapeutic effects of several TCHMs in CKD. However, the level of evidence supporting TCHMs is limited to small, nonrandomized trials. Due to variations in the prescription pattern of TCHMs and the need for frequent dosage adjustment, which are inherent to the practice of traditional Chinese medicine, it has been challenging to design and implement large randomized clinical trials of TCHMs. Several TCHMs are associated with significant adverse effects, including nephrotoxicity. However, reporting of adverse effects associated with TCHMs has been inadequate. To fully realize the therapeutic use of TCHMs in CKD, we need molecular studies to identify active ingredients of TCHMs and their mechanism of action, rigorous pharmacologic studies to determine the safety and meet regulatory standards required for clinical therapeutic agents, and well-designed clinical trials to provide evidence-based support of their safety and efficacy.

Introduction

Corticosteroid and immunosuppressive medications are cornerstone therapies for glomerular diseases. However, these medications are associated with serious side effects. Furthermore, resistance to therapy and relapse of disease after discontinuation of medication are common. For patients with chronic kidney disease (CKD), modulation of the renin–angiotensin axis provides only partial salutary effects and does not necessarily prevent the progression to end-stage renal disease and the need for renal replacement therapy.[1] The lack of therapeutic options for CKD has prompted patients in China and other Asian countries to seek out alternative treatment such as traditional Chinese herbal medications (TCHMs).

The practice of traditional Chinese medicine (TCM) is largely guided by the cumulative empirical experience of its practitioners. Although many small clinical studies suggest a therapeutic potential for TCHMs in CKD, large randomized trials are lacking. Some TCHMs are known to cause nephrotoxicity, which are often overlooked by some physicians and patients because of the incorrectly held belief that herbal medications are innocuous. Another major concern is that the active component(s) in most TCHM formulas and their underlying mechanism of action remain unidentified. Despite these concerns, significant progress has been made in the past decade. However, recent reviews of this topic in the English language are limited.[2–4]

In this review, we reviewed the current knowledge of TCHMs for the treatment of CKD based on publications in peer-reviewed journals of the English language. We also render a prospective on the direction of future investigation. Our target audience includes clinical nephrologists who care for patients being treated with TCHMs and basic scientists who are interested in the drug discovery pertaining to TCHMs.

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