MO627: Effectiveness of Integrative Chinese–Western Medicine for Chronic Kidney Disease and Diabetes: A Retrospective Cohort Study

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) and diabetes are key contributors of disability-adjusted life years globally awaiting more therapeutic options. This registry-based retrospective cohort study aimed to evaluate the effectiveness, safety profile and prescription pattern of a pilot integrative Chinese–Western medicine service program in Hong Kong. METHOD Data from 38 patients with diabetes and CKD received 48 weeks of individualized add-on Chinese medicine (CM) were retrieved from electronic hospital database. Patients from the same source were matched by propensity score to generate a 1:1 cohort. Primary outcomes were the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance (ANCOVA) and mixed-effect regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Rate of adverse events and the change of key biochemical parameters were also analyzed. RESULTS After a median follow-up of 51 weeks, patients who received add-on CM had stabilized eGFR [0.74 mL/min/1.73 m2 (95% CI −1.01–2.50)] and UACR [0.95 (95% CI 0.67–1.34)]. Add-on CM was associated with significantly preserved eGFR [inter-group difference: 3.19 mL/min/1.73 m2 (95% CI 0.32–6.06), P = 0.030] compared with standard care. The intergroup ratio of UACR were comparable [0.70 (95% CI 0.45–1.08), P = 0.104] between groups. The result is robust in sensitivity analysis with different statistical methods. The rate of serious adverse events (8.1% versus 18.9%, P = 0.174), moderate-to-severe hyperkalemia (8.1% versus 2.7%, P = 0.304) and hypoglycemia (13.5% versus 5.4%, P = 0.223), and the levels of key biochemical parameters were comparable between groups. Top 7 most used CMs contained two classical formulations namely Liu-wei-di-huang-wan and Si-jun-zi-tang. CONCLUSION Add-on individualized CM was associated with kidney function preservation. Further randomized controlled trial using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang is warranted.