Integration of Chinese Herbal Medicine into Routine Care Was Related to Lower Risk of Chronic Kidney Disease in Patients with Rheumatoid Arthritis: A Population-Based Nested Case–Control Study in Taiwan

Abstract

Objective

Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used as the first-line agents for the symptomatic relief of rheumatoid arthritis (RA), but it may insidiously provoke the onset of renal diseases, especially chronic kidney disease (CKD). While Chinese herbal medicine (CHM) has become an increasingly popular adjunctive therapy among RA groups, there are currently no available data on the effect of CHM use towards risk of CKD. This study aimed to explore on a population-level whether CHM use decreases sequent CKD risk among them.

Methods

In this nested case–control study retrieved from the nationwide insurance database of Taiwan from 2000 to 2012, we looked at the association between CHM use and the likelihood of developing CKD, with a focus on usage intensity. Cases with CKD claims were defined and matched to one randomly selected control case. Conditional logistic regression was then applied to estimate odds ratio (OR) of CKD from CHM treatment measured before the index date. For each OR, we calculated a 95% confidence interval for CHM use relative to the matched control.

Results

This nested case–control study included 5464 patients with RA, where after matching comprised 2712 cases and 2712 controls. Among them, there were 706 and 1199 cases that ever received CHM treatment, respectively. After the adjustment, CHM use in RA individuals was related to a lower likelihood of CKD, with an adjusted OR of 0.49 (95% CI: 0.44–0.56). Additionally, a dose-dependent, reverse association was found between the cumulative duration of CHM use and risk of CKD.

Conclusion

Integrating CHM into conventional therapy may reduce the likelihood of developing CKD, which could be a reference in instituting novel preventive strategies to improve treatment outcomes and reduce related fatalities for RA subjects.

Keywords:

• rheumatoid arthritis
• chronic kidney disease
• Chinese herbal medicine
• nested case–control study

Acknowledgment

This study obtained data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, managed by the Department of Health and Welfare, Taiwan. The main mission of the authority is to ensure that universal participation and equal-opportunity of medical care are being fulfilled. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or of the National Health Research Institutes. HHL, HTC, HL and HLH equally contributed to this work.

Author Contributions

All authors made a significant contribution to the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was supported by Dalin Tzuchi Hospital (Grant Number DTCRD 110-E-19). The funders had no participation in any aspect of this work.