Abstract

Background: Preserving residual kidney function (RKF) is a priority in the management of chronic kidney disease (CKD), including patients with end-stage kidney disease receiving maintenance hemodialysis. Better RKF is associated with improved survival, less restrictive fluid and dietary limitations, improved removal of middle molecules, more stable hemoglobin and electrolyte profiles, and better nutritional status and quality of life.
Objective: To observe whether oral administration of Cistanche (Rou Cong Rong), a traditional herbal tonic, supports residual kidney function and dialysis adequacy in maintenance hemodialysis patients.
Methods: A self-controlled (before–after) observation was conducted in 90 maintenance hemodialysis outpatients from October 2007 to March 2010. The observation period lasted 6 months, excluding April–September to minimize sweating-related confounding. Patients received routine hemodialysis and standard medical management throughout. The first 3 months served as the control period (routine care only), and the subsequent 3 months served as the Cistanche period (routine care plus Cistanche decoction).
Key outcomes: 24-hour urine volume during the interdialytic interval, pre-dialysis body weight, mean arterial pressure, ultrafiltration volume, BUN, phosphorus, hemoglobin, albumin, LDL-C, and CRP; adverse events and bowel habits were also recorded.
Results: During the Cistanche period, multiple indicators improved significantly by month 2 compared with month 1 (P < 0.05), and remained stable at month 3. No notable adverse reactions (abdominal pain, diarrhea, fever, rash) were reported. Constipation improved in many patients.
Conclusion: In this clinical observation, Cistanche appeared safe and was associated with improved indicators consistent with better RKF and dialysis adequacy. Larger randomized controlled trials are needed to confirm efficacy.

Keywords: Cistanche; residual kidney function; hemodialysis; CKD stage 5; traditional Chinese medicine; herbal adjunctive care

 

 

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1. Introduction (Why Residual Kidney Function Matters in Dialysis)

Protecting residual kidney function (RKF) is a primary task in treating chronic kidney disease. Even for CKD stage 5 patients receiving hemodialysis, better RKF can meaningfully improve outcomes-such as patient survival, reduced excessive restrictions on diet and fluid intake, improved clearance of middle-molecular-weight solutes, more favorable maintenance of hemoglobin, phosphorus, potassium, and urea levels, and improved nutritional status and quality of life.

The U.S. clinical practice guidelines NKF-K/DOQI recommend incorporating RKF into the evaluation of dialysis adequacy and emphasize control of volume status, dry weight, blood pressure, and improvement of patient-reported well-being.

Traditional Chinese medicine (TCM) has been used as adjunctive care to improve dialysis adequacy and support RKF. Single-herb therapy is often favored for its clearer pharmacological identity and convenient administration.

 

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2. Materials and Methods

2.1 Participants (General Information)

A total of 90 outpatient maintenance hemodialysis patients were enrolled from:

Department of Nephrology, Hebei Geriatric Hospital (16 cases)

Department of Nephrology, Hebei Youai Hospital (14 cases)

Department of Nephrology, Affiliated Hospital of Hebei University (30 cases)

Department of Nephrology, Peking University Third Hospital / Peking University Health Science Center (30 cases)

Sex: 48 male, 42 female
Age: 55.0±8.555.0 \pm 8.555.0±8.5 years
Disease course: 11.0±5.611.0 \pm 5.611.0±5.6 years
Primary diseases: chronic glomerulonephritis (36), hypertensive renal damage (28), drug-induced renal damage (10), polycystic kidney disease (5), gouty nephropathy (5), others (6)

 

 

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2.2 Diagnostic Criteria

2.2.1 Diagnostic Standard

Diagnosis of advanced-stage uremia due to chronic renal failure followed the criteria in Practical Internal Medicine.

2.2.2 Inclusion Criteria

Patients met all of the following:

Met diagnostic criteria

Maintenance hemodialysis for > 2 years

Regular hemodialysis: 3 sessions/week, 4 hours/session

Long-term vascular access: arm arteriovenous fistula; blood flow > 200 mL/min

Interdialytic 24-hour urine volume > 400 mL

Not chronic diarrhea

TCM pattern differentiation: spleen-kidney yang deficiency with deficiency in origin and excess in manifestation

No acute infection or cerebrovascular/cardiovascular events during the treatment course

Project funding source: 2009 Hebei Administration of Traditional Chinese Medicine Research Plan (No. 2009054)

 

 

Table 1. Comparison of related indicators between two phases ( xˉ±s\bar{x} \pm sxˉ±s )

Indicator	Control Month 1 (n=90)	Control Month 2 (n=90)	Control Month 3 (n=90)	Cistanche Month 1 (n=90)	Cistanche Month 2 (n=90)	Cistanche Month 3 (n=90)
Interdialytic 24‑h urine volume (mL)	600.0 ± 130.0	650.0 ± 80.0	680.0 ± 50.0	700.0 ± 40.0	800.0 ± 30.0*	810.0 ± 40.0
Mean pre‑dialysis body weight (kg)	72.0 ± 3.0	72.0 ± 2.8	72.0 ± 2.4	71.0 ± 2.0	66.0 ± 2.4*	65.0 ± 2.5
Mean pre‑dialysis blood pressure (kPa)	12.7 ± 1.1	12.7 ± 0.9	12.7 ± 1.1	12.2 ± 0.8	10.6 ± 0.7*	10.6 ± 0.7
Mean monthly ultrafiltration volume (kg)	4.0 ± 0.4	4.0 ± 0.4	4.0 ± 0.3	3.9 ± 0.3	3.2 ± 0.3*	2.9 ± 0.3
BUN (mmol/L)	30.3 ± 3.5	29.8 ± 3.0	29.9 ± 3.0	28.7 ± 3.0	23.0 ± 2.4*	23.0 ± 2.0
Phosphorus, P (mmol/L)	3.6 ± 0.3	3.5 ± 0.4	3.4 ± 0.4	3.3 ± 0.3	2.5 ± 0.3*	2.4 ± 0.3
Hemoglobin, Hgb (g/L)	106.0 ± 4.0	107.0 ± 4.5	108.0 ± 4.0	110.0 ± 3.5	117.0 ± 3.0*	118.0 ± 3.0
Albumin, Alb (g/L)	34.0 ± 3.2	35.0 ± 3.0	34.0 ± 2.7	35.0 ± 2.0	41.0 ± 3.0*	41.0 ± 2.0
LDL‑C (mmol/L)	4.0 ± 0.3	4.0 ± 0.3	4.0 ± 0.3	3.9 ± 0.3	3.4 ± 0.2*	3.3 ± 0.3
CRP (g/L)	6.6 ± 2.0	5.2 ± 1.3	5.1 ± 1.2	4.8 ± 1.0	2.6 ± 0.8*

 

 

2.3 Treatment Protocol (Self-Controlled Observation)

A continuous 6-month observation was performed:

Months 1–3: Control period (routine care + routine hemodialysis)

Months 4–6: Cistanche period (routine care + routine hemodialysis + oral Cistanche)

To reduce confounding from sweating, the observation period avoided April to September.

2.3.1 Control Period: Routine Care Only

Patients received routine management including medications for glycemic control, blood pressure control, lipid management, correction of calcium-phosphorus metabolism, and anemia management. Hemodialysis regimen:

3 times/week (every other day), 4 hours per session

Blood flow: 200–250 mL/min

Dialysate flow (bicarbonate): 500 mL/min

Dialysis machines: Braun Dialog and Fresenius 4008B

Dialyzer: polysulfone hollow-fiber membrane; area 1.3 m² for the first 3 sessions, then 1.5 m² or 1.7 m²

Anticoagulation: standard protocol with unfractionated heparin or low molecular weight heparin

2.3.2 Cistanche Period: Added Cistanche Decoction

On top of the control-period regimen, patients received Cistanche (Rou Cong Rong) 30 g/day, prepared as a decoction:

30 g per dose, once daily

Decoction reduced to 100 mL

Taken frequently as a tea substitute ("instead of tea"), once per day

2.4 Outcomes (Observation Indicators)

Measured at the end of each month:

Interdialytic 24-hour urine volume

Monthly average pre-dialysis body weight

Monthly average pre-dialysis mean arterial pressure and ultrafiltration volume

Pre-dialysis labs: BUN, phosphorus, hemoglobin, albumin, LDL-C, CRP
Also recorded:

Withdrawals, adverse reactions, and changes in bowel habits

2.5 Statistical Analysis

SPSS 11.5 was used. Data were expressed as mean ± SD (xˉ±s\bar{x} \pm sxˉ±s). t-test was applied.

 

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3. Results

3.1 Comparison of Outcomes Between Periods

Both periods showed gradual improvement in related indicators. However:

In the control period, differences compared with the previous month were not statistically significant (P > 0.05).

In the Cistanche period, improvements were significant by the second month compared with the first month (P < 0.05).

By the third month of the Cistanche period, indicators remained stable with no significant difference compared with the second month (P > 0.05).

Overall interpretation in the source text: Cistanche was associated with enhanced removal of water and solutes, increased residual urine volume, support of RKF, improved control of dry weight, ultrafiltration volume, and blood pressure, improved nutritional and inflammatory status, and improved dialysis adequacy, with stable and sustained effects.

(Note: Table 1 is referenced in the source text but not included in the excerpt provided.)

3.2 Safety and Other Observations

No participants withdrew during the observation.

No adverse drug reactions such as abdominal pain, diarrhea, fever, or rash were observed.

No new-onset constipation occurred.

Among 76 patients with pre-existing constipation, constipation improved significantly in 64 cases during the Cistanche period.

 

4. Discussion

4.1 TCM Rationale in Dialysis Support

In TCM theory, chronic renal failure aligns with categories such as "Guan Ge," edema, and urinary obstruction, guided by principles described in the Inner Canon such as "opening the pores," "clearing the bowels," and "removing old stagnation."

For maintenance hemodialysis, the underlying pattern is described as depletion of spleen and kidney yin-yang as the root, with damp turbidity and toxin as the manifestation. Therapeutic strategies include purging turbidity via the bowels, tonifying spleen and kidney, and supporting RKF while preventing complications-often by combining dialysis with herbal strategies (single herbs or formulas).

Rhubarb (Da Huang) is discussed as a representative herb for purging turbidity and supporting RKF, but long-term use may be limited by issues related to preparation, properties, and suitability for long-term drinking. Cistanche, in contrast, is described as both laxative-moistening and kidney-tonifying, and thus more suitable for hemodialysis patients.

4.2 Why Cistanche (Rou Cong Rong) Was Considered Suitable

The source describes Cistanche as sweet and salty in flavor, warm in nature, moist in texture, entering the kidney and large intestine meridians. It is characterized as gentle, "tonifying without harshness," "tonifying with movement," and not overly cloying-therefore suitable for long-term use.

4.3 Observed Clinical Implications

In this observation, the Cistanche period was associated with:

Increased residual urine volume

Improved constipation

Reduced ultrafiltration volume, dry weight, and mean arterial pressure

Lower metabolic indicators (BUN, phosphorus, LDL-C)

Higher nutritional indicators (albumin and hemoglobin)
These changes were interpreted as consistent with supporting RKF, improving nutritional status, reducing inflammatory status, and improving dialysis adequacy.

4.4 Modern Pharmacology Notes (As Presented in the Source)

The source reports that Cistanche water extract may:

Enhance intestinal motility and shorten defecation time in mice

Enhance cellular and humoral immunity

Promote metabolism, improve physical strength, and exert antioxidant/anti-aging effects

Support endocrine function
It also lists reported effects such as hepatoprotection, anti-myocardial ischemia, anti-atherosclerosis, blood pressure-lowering, promotion of urination, and reduction of blood BUN, with no toxicity/side effects reported in the cited references.

 

5. Practical Consumer-Facing Topic: "What Herbs Are Better to Take During Hemodialysis?"

For SEO and consumer education, it is important to position this appropriately:

Hemodialysis patients should prioritize medical management, dialysis prescription adherence, and diet plans provided by clinicians (fluid, sodium, potassium, phosphorus, protein).

Herbal support, when considered, should be treated as adjunctive wellness support, and should be discussed with the dialysis team due to interactions and electrolyte risks.

Cistanche (Rou Cong Rong) is often discussed in TCM as a kidney-tonifying herb and, in this clinical observation, was used as a daily decoction (30 g/day) during maintenance hemodialysis. The study's endpoints included interdialytic urine volume, blood pressure-related measures, and nutritional/inflammation markers, which are relevant to "dialysis adequacy" and quality-of-life concerns like constipation and fatigue.

 

6. Conclusion

This self-controlled clinical observation suggests that adding Cistanche (Rou Cong Rong) decoction to routine care in maintenance hemodialysis patients may be associated with improvements in indicators consistent with better residual kidney function and dialysis adequacy, while appearing safe within the observation period.
Because the design was not randomized and the tabled numeric outcomes were not provided in the excerpt, future well-designed randomized controlled trials are warranted to confirm efficacy and define optimal dosing and safety monitoring.

 

References 

Ren Wei, Lan Lei. The importance of protecting residual renal function in dialysis patients. Foreign Medical Sciences: Geriatrics Fascicle, 2007, 28(4):185–188.

Fu Haixia, An Maozhu. Importance and strategies for protecting residual renal function in dialysis patients. Chinese Journal of Blood Purification, 2006, 5(3):160–162.

Wang Zhigang. Re-discussion on hemodialysis adequacy. Chinese Journal of Blood Purification, 2008, 7(6):291–292.

Che Shuqiang, Sun Lanyun, Zhang Daning. Advances in treatment of chronic renal failure hemodialysis combined with Chinese medicine therapy. Shaanxi Journal of Traditional Chinese Medicine, 2003, 24(11):1052–1053.

Chen Haozhu (Ed.). Practical Internal Medicine, 12th ed. Beijing: People's Medical Publishing House, 2005:2078–2113.

Wang Yongyan, Yan Shiyun. Practical Traditional Chinese Internal Medicine, 2nd ed. Shanghai: Shanghai Scientific & Technical Publishers, 2009:382–388.

Zhang Tingmo. Chinese Materia Medica. Beijing: China Press of Traditional Chinese Medicine, 2000:104–105.

Wang Zhongzhuang, Hu Jinhong. Modern Chinese Materia Medica. Shanghai: Second Military Medical University Press, 2006:352–354.

Shen Pian. Chinese Medicine Pharmacology and Clinical Application. Beijing: People's Medical Publishing House, 2006:177–179.