title: Non-aristolochic acid prescribed Chinese herbal medicines and the risk of mortality in patients with chronic kidney disease: results from a population-based follow-up study.
abstract: OBJECTIVE
  To evaluate the relationship between the use of non-aristolochic acid (AA) prescribed Chinese herbal medicines (CHMs) and the risk of mortality in patients with chronic kidney disease (CKD).
  
  
  METHODS
  Nationwide population-based follow-up study.
  
  
  METHODS
  Longitudinal health insurance database sampled from the Taiwan National Health Insurance Research Database.
  
  
  METHODS
  A total of 47 876 patients with CKD were identified. Participants who had ever used AA-containing CHMs, had cancer or HIV prior to the diagnosis of CKD, died within the first month of CKD diagnosis and who were not Taiwanese citizens were excluded. A total of 13 864 participants were eligible for final analysis.
  
  
  METHODS
  All-cause mortality among patients with CKD between 2000 and 2008.
  
  
  RESULTS
  After controlling for potential confounders, we found that participants who started to receive non-AA prescribed CHMs after the diagnosis of CKD had a lower risk of mortality as compared with non-users of non-AA prescribed CHMs (adjusted HR (aHR) 0.6; 95% CI 0.4 to 0.7, p<0.001). Moreover, participants who had used non-AA prescribed CHMs prior to and after the diagnosis of CKD also had a lower risk of mortality than non-users (aHR 0.6; 95% CI 0.5 to 0.8, p<0.001). In subgroup analyses, we found that such an inverse association was present only among patients who were not eligible to receive erythropoietin therapy (ie, serum creatinine ≦6 mg/dL and/or haematocrit value ≧28%).
  
  
  CONCLUSIONS
  Patients who received non-AA prescribed CHMs after the diagnosis of CKD, yet before the start of erythropoietin therapy had a lower risk of mortality than those who did not.
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chuan Fa
authors.initials: CF
authors.lastname: Hsieh
authors.forename: Song Lih
authors.initials: SL
authors.lastname: Huang
authors.forename: Chien Lung
authors.initials: CL
authors.lastname: Chen
authors.forename: Wei Ta
authors.initials: WT
authors.lastname: Chen
authors.forename: Huan Cheng
authors.initials: HC
authors.lastname: Chang
authors.forename: Chen Chang
authors.initials: CC
authors.lastname: Yang
mesh_terms: D034341:Aristolochic Acids / Q000494:pharmacology*; D004365:Drugs, Chinese Herbal / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal; C000228:aristolochic acid I
keywords: Aristolochic Acid; Chronic Kidney Disease; Prescribed Chinese Herbal Medicine