High prevalence of fenfluramine-related aortic regurgitation in women with end-stage renal disease secondary to Chinese herb nephropathy.
BACKGROUND
Non-controlled studies have noted a high prevalence of valvular regurgitation in patients with Chinese herb nephropathy; most of these patients had taken appetite suppressants. We aimed to determine the prevalence of valvular regurgitation and the role of appetite suppressants in patients with Chinese herb nephropathy.


METHODS
This case-controlled echocardiographic study included 40 patients with end-stage renal failure due to Chinese herb nephropathy and 37 age-matched controls with end-stage renal disease due to nephropathy of other origin. Quantification of cumulative doses of appetite suppressants was performed.


RESULTS
Aortic regurgitation was detected in 52.5% of patients with Chinese herb nephropathy, 72+/-1 months after stopping appetite suppressants, and in 21.6% of controls (P=0.009). No difference was found in the incidence of mitral or tricuspid regurgitation. A history of slimming medication was the only significant determinant for aortic regurgitation (P=0.009). Higher cumulative doses of Chinese herbs, (dex)fenfluramine and diethylpropion were observed in patients with Chinese herb nephropathy with, when compared to those without, aortic regurgitation. The dose-response relationship between the cumulative dose of drugs and the presence of aortic regurgitation was significant for fenfluramine only (chi-square=5.16, P=0.024).


CONCLUSIONS
Six years after stopping appetite suppressants, aortic regurgitation remains highly prevalent among patients with end-stage Chinese herb nephropathy. The dose-related association with fenfluramine intake strongly confirms a determinant pathogenic role of anorectic drugs.
Unger
Philippe
P
Cardiology and Nephrology Departments, Erasme Hospital, 808 route de Lennik, B-1070 Brussels, Belgium. punger@ulb.ac.be
Nortier
Joëlle
J
Muniz Martinez
Marie-Carmen
MC
Plein
Danièle
D
Vandenbossche
Jean-Luc
JL
Vereerstraeten
Pierre
P
Vanherweghem
Jean-Louis
JL
D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D001067:Appetite Depressants / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D015150:Echocardiography, Doppler; D005260:Female; D005277:Fenfluramine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000209:etiology*; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
D001067:Appetite Depressants; D004365:Drugs, Chinese Herbal; D005277:Fenfluramine