Association Between Aristolochic Acid and CKD: A Cross-sectional Survey in China

Background Long-term intake of herbs containing aristolochic acid (AA) has been reported to be associated with increased risk of chronic kidney disease (CKD), whereas population-based studies are limited. Study Design Cross-sectional study. Setting & Participants A national representative sample of 47,204 adults in China. Predictor Self-reported long-term use of medications containing AA. Outcomes & Measurements CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or the presence of albuminuria, defined as albumin-creatinine ratio >30 mg/g. Results 467 participants reported long-term AA intake, with a prevalence adjusting for a synthesized weight of 1.5% (95% CI, 1.2%-1.7%). After adjusting for age, sex, and other potential confounders, long-term AA intake was associated with eGFR <60 mL/min/1.73 m2 and albuminuria, with ORs of 1.83 (95% CI, 1.22-2.74) and 1.39 (95% CI, 1.03-1.87), respectively. Further adjustment for intake of nonsteroidal anti-inflammatory drugs did not change ORs substantially. A positive association between accumulated time of AA intake and kidney disease also was observed, with fully adjusted ORs of 1.07 (95% CI, 1.03-1.12) per 6-month longer intake for eGFR <60 mL/min/1.73 m2 and 1.04 (95% CI, 1.01-1.08) per 6-month longer intake for albuminuria. Limitations Self-reported intake of herbs containing AA; the AA content of the preparations by weight was unknown; single measurement of indicators of kidney damage. Conclusions Long-term intake of medications containing AA is prevalent in China and is associated with the presence of CKD. Long-term intake of herbs containing aristolochic acid (AA) has been reported to be associated with increased risk of chronic kidney disease (CKD), whereas population-based studies are limited. Cross-sectional study. A national representative sample of 47,204 adults in China. Self-reported long-term use of medications containing AA. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or the presence of albuminuria, defined as albumin-creatinine ratio >30 mg/g. 467 participants reported long-term AA intake, with a prevalence adjusting for a synthesized weight of 1.5% (95% CI, 1.2%-1.7%). After adjusting for age, sex, and other potential confounders, long-term AA intake was associated with eGFR <60 mL/min/1.73 m2 and albuminuria, with ORs of 1.83 (95% CI, 1.22-2.74) and 1.39 (95% CI, 1.03-1.87), respectively. Further adjustment for intake of nonsteroidal anti-inflammatory drugs did not change ORs substantially. A positive association between accumulated time of AA intake and kidney disease also was observed, with fully adjusted ORs of 1.07 (95% CI, 1.03-1.12) per 6-month longer intake for eGFR <60 mL/min/1.73 m2 and 1.04 (95% CI, 1.01-1.08) per 6-month longer intake for albuminuria. Self-reported intake of herbs containing AA; the AA content of the preparations by weight was unknown; single measurement of indicators of kidney damage. Long-term intake of medications containing AA is prevalent in China and is associated with the presence of CKD.