Chinese Herbal Medicine in the Treatment of Chronic Kidney Disease: A Narrative Review of Mechanisms and Therapeutic Potential

Abstract

Context: Chronic kidney disease (CKD) is a significant global health issue, characterized by its progressive nature and the limited effectiveness of conventional treatments. Chinese herbal medicine (CHM) has been used for centuries in East Asia to manage CKD by targeting key pathological processes. This review focuses on synthesizing evidence from various studies to explore the potential role of CHM in managing CKD, particularly through classical formulations, individual herbs, and their bioactive compounds with known nephroprotective effects. Evidence Acquisition: The review synthesizes evidence from preclinical studies, randomized controlled trials (RCTs), and meta-analyses to assess the effectiveness of CHM in CKD management. It highlights the use of classical CHM formulations like Liuwei Dihuang decoction, Zhenwu decoction, Shen-Qi-Wan (SQW), and Yu-Quan Wan (YQW), which are based on CHM theory and syndrome differentiation. Additionally, individual herbs such as Astragalus membranaceus, Salvia miltiorrhiza, Rheum officinale, Tripterygium wilfordii Hook F (TwHF), and Cordyceps sinensis are discussed for their nephroprotective bioactive compounds that provide multi-targeted effects, including anti-inflammatory, anti-fibrotic, antioxidant, and immunomodulatory actions. Results: Integration of CHM with standard therapy has shown promising results in improving renal function and reducing proteinuria, especially in patients with CKD and IgA nephropathy (IgAN). Evidence supports the multi-mechanistic actions of CHM, including the potential for its anti-inflammatory, anti-fibrotic, antioxidant, and immunomodulatory effects to positively impact CKD progression. Conclusions: Despite the growing body of evidence supporting the therapeutic value of CHM in CKD management, challenges still exist, such as the standardization of herbal preparations, ensuring safety, and gaining regulatory approval. For CHM to be more broadly integrated into evidence-based nephrology practice, further high-quality clinical research and harmonization of regulatory frameworks will be crucial. Overall, CHM offers a complementary approach to CKD treatment that aligns with classical principles and multi-targeted actions, contributing to a broader global strategy for CKD management.