Therapeutic use of traditional Chinese herbal medications for chronic kidney diseases

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.

Figure 1. Schematic outlining evidence-based investigation of traditional Chinese herbal medications (TCHM)

Future studies are required to identify active compounds from TCHM, and determine their molecular mechanism of action. Well-designed animal studies and randomized clinical trials are needed to validate the physiological and pathological roles of these agents for treatment of patients with kidney disease. Complementary use of western and eastern medicines for treatment of kidney disease will also need to be further defined and proven.

Figure 2. Chemical structures of active compounds in herbal medications used for treatment of kidney diseases in TCM

Rhein and emodin are isolated from rhubarb. Saikosaponin a (SSa) and its epimer saikosaponin d (SSd) are major triterpenoid saponin derivatives from Radix bupleuri. Triptolide, a diterpene triepoxide, is one of the major active components isolated from the extracts of Tripterygium wilfordii Hook F.