Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Hypotension in Patients with End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Abstract Hypotension during hemodialysis (HD) is a common complication of dialytic patients that imposes an enormous burden on the healthcare system. A few studies show that Chinese herbal medicine (CHM) treatments confer a protective effect on hypotension in HD patients, but the long-term impact remains unclear. This study investigated the adjuvant therapy of CHM in HD patients to prevent the risk of hypotension in HD patients. We extracted data from the Taiwanese National Health Insurance Registry for Catastrophic Illness Patient Database (NHI_RCIPD) from 2008 and 2018 and analyzed them using multivariate Cox proportional hazard regression models. After 1:1 frequency-matching by age, index date, HD duration, monthly income, residential area, and medical comorbidities, 3820 HD patients who were using CHM and 3820 who were not using CHM were identified as CHM users and CHM non-users, respectively. The occurrence of taking vasopressors was identified as intradialytic hypotension (IDH). The Kaplan–Meier method was used to estimate the cumulative incidence curves of vasopressors of the subjects during the follow-up period. During 12 years of follow-up, 1710 CHM users and 1927 CHM non-users were prescribed vasopressors, representing IDH incidence rates of 119.8 and 246.2 per 1000 person-years, respectively. CHM users had significantly lower IDH risk compared with CHM non-users (adjusted HR = 0.51; 95%CI = 0.48, 0.55). A markedly predominant effect was observed in those receiving CHM for more than 180 days (adjusted HR = 0.43; 95%CI = 0.39, 0.48). Lower vasopressor use and IDH risk among HD patients correlated with the use of CHM treatments. Further studies about specific CHM modalities or medications for IDH are still needed.