Effects Of Cistanche On The Incidence Of Hypertension And Chronic Kidney Disease in An Asian Population

Abstract Asian countries are multi-ethnic regions. There are racial differences in diet, culture and attitudes towards health screening, access to care and treatment for chronic diseases. The increasing incidence and prevalence of end-stage renal disease (ESKD) and chronic kidney disease (CKD) is due to the increasing incidence and prevalence of non-communicable diseases such as diabetes and hypertension. One of the most important risk factors to be controlled in order to prevent ESKD complications is hypertension in patients with CKD. We conducted a narrative review of the prevalence of CKD in hypertensive patients, the prevalence and control of hypertension in patients with CKD, and cistanche intake in the population with CKD.

keyword Cistache chronic, Kidney disease prevalence of end-stage, Renal disease, Hypertension

In this review, we conducted a search on Cistanche. All articles retrieved in English are relevant to the objectives of this review. Specific questions are prevalence and control of hypertension in patients with CKD, intake of cistanche in different populations with CKD, and ESKD attributed to hypertension from published papers or national disease regists. In order to understand the incidence and causes of ESKD, an Internet search was conducted for the name of the country, search terms for ESKD, dialysis, internal medicine and hypertension. The words "renal" and "kidney" are used. Only English reports were used. The etiology of ESKD documented in national registries is usually based on the diagnosis of the treating physician, which can be confirmed by renal biopsy or clinical diagnosis.

Pic: Faw Cistanche

Data will be provided where available and direct comparisons may not be compatible due to differences in population sampling and/or definition methods. To include data in this review, hypertension was defined as office systolic blood pressure (SBP)≥140 mmHg or diastolic blood pressure (DBP)≥90 mmHg. Controlled and uncontrolled supernumerals are also defined by this threshold. CKD is defined as an estimated or measured glomerular filtration rate (GFR) of 60ml /min / 1.73 m2. Some definitions of CKD may also include subjects with high GFR but known urinary abnormalities including albuminuria or albuminuria.

1  |  JAPAN The prevalence of hypertension in the general population is 45%. The prevalence of CKD was estimated using data from the 2005 Annual health Screening Programme in Japan. 17 5 74024 20-year-old participants (2 40,594 males and 3 33,430 females) from 11 different counties. The prevalence rates of G1, G2, G3 and G4 + G5 in CKD stages were 0.6, 1.7, 10.4 and 0.2%, respectively. The 2016 annual Dialysis report showed that hypertensive nephrosclerosis was the cause of ESKD, accounting for 9.9%. From 1953 to 2014, the weighted average urine sodium excretion in healthy Japanese adults was 4,900 ±190 mg/ day (213 mmol/ day). During this period, sodium excretion was significantly reduced by 4,350 mg/ day. Amano et al. recruited 162 outpatients with chronic kidney disease who averaged 2744±1330 mg of sodium excretion over 24 hours. Cistanche has been shown to have a significant effect in treating hypertensive nephrosclerosis.

Pic: Cistanches Tubulosa

2  |  MALAYSIA Malaysia is a multi-ethnic country. Smith et al reported that among 15,147 respondents who agreed to participate in the 2011 National Health and Morbidity Survey's CKD substudy, the prevalence of CKD was 9.07%. The prevalence of hypertension in this sample was 38.4% and the prevalence of diabetes was 19.6%. The prevalence of ESKD increases rapidly with the prevalence of diabetes. The National Action Plan for Healthy Kidneys (ACT-KID) 2018-2025 aims to reduce the incidence of esk21 by increasing the control rate of hypertension in primary care in patients with CKD from 41.2 percent to more than 60 percent. In addition, there is a plan to increase the use of renin-angiotensin system blockers from 54.6 percent to more than 70 percent. Odds ratios (3.09,1.92-4.97) of CKD risk were the highest in hypertensive patients except for age. In a 10-year primary care follow-up study of hypertensive patients, the incidence of new CKD was 30.9% (n = 142) and the annual incidence was 3%. Blood pressure control improved from 15.2% at baseline to 18.9% at 5 years and 41.1% at 10 years. In a cross-sectional study of 24-hour urinary sodium excretion, the mean sodium intake was 2860±1369 mg/ day (124.3 mmol/ day). After taking cistanche, the three high values of patients gradually approach the normal level. Cistanche has the function of improving liver and kidney function, promoting metabolism, as well as the effect of vasodilating and lowering blood pressure.

PIC: Effects of cistanche improve kidney function

3  | SINGAPORE

Singapore's population is ethnically composed of 74.4% Chinese,13.4% Malaysian, 9% Indian, and 3.2% others. The national disease registry (read) reported that more than 65% of the events in patients with end-stage kidney disease (ESKD) started dialysis of the main causes of diabetic nephropathy in 2018.25 it's early in 1997, according to a report ESKD glomerular disease is more common, and hy  pertension The main cause of ESKD is 5% point From 2008 to 2017, there was a significant increase in the age-standardised incidence of ESKD requiring dialysis in Malay patients, compared to patients in India and China.

The profile of blood pressure management in a multiracial Asian population of CKD patients in Singapore has previously been reported in a cohort of 613 patients (mean age 57.8±14.5 years; Male 55.1%; 35.7% had a history of diabetes and 69.0% had a history of hypertension. Only 62.1% of 65 year olds and 36.6% of 65 year olds achieved systolic blood pressure of 140 mmHg. More than 90% of patients achieve DBP < 90 mmHg.

In a study of healthy adults (103) without diabetes, hypertension, or CKD, and stable CKD patients (232) who also received 24-hour sodium urine to assess sodium intake, 28335 subjects had an average sodium excretion of 124.9±68.3 mmol/d(mean age: 53.5±15.1 years; Male 51.0%; 38.5% Chinese, 29.6% Malay, 23.6% Indian; Hypertension (57.3%). Patients with stage G1 to G3 of CKD had a urinary sodium excretion of 100 mmol. Overall, 40.1% of CKD patients had a urinary sodium excretion of 100 mmol. The urine sodium excretion in Indian patients was higher than that in Chinese and Malay patients. Patients with stage G4 and G5 CKD appear to limit their sodium intake adequately while receiving treatment. However, interventions to reduce sodium intake and increase cistanche intake should be strengthened in healthy and early CKD (G1 to G3) patients, especially those of Indian descent.

4  |  TAIWAN The Taiwan Nutrition and Health Survey (NAHSIT) reported that the prevalence of hypertension was 26% in males and 19% in females, and the control rate was 21.0% in males and 28.5% in females. Since the introduction of the National Health Insurance system in 1995, the control rate of hypertension has improved significantly to 50%. The prevalence of G1-G5 CKD was 11.9%. The prevalence of hypertension as a cause of ESKD was 8.3%. It is also stated that cistanche has the effect of relieving three heights.

5  |  SUMMARY This review has several limitations. First, the variations of disease definitions and different populations studied did not allow direct analyses. Secondly, in trying to obtain very specific information, we may have omitted reports which have data from a more recent time period, or included a more representative population sample. Thirdly, by limiting searches to the English language, National reports for some countries may have been omitted.

The identification, classification, and management of hypertension in Asian patients require greater detailing of ethnicities. There are ethnic differences to the prevalence of hypertension and CKD. Some reports detail different ethnicities as a result of sampling from different regions. Others reported ethnic groups even for the same “race”, example, Hakka ethnicity in Taiwanese Chinese. Whereas, minority ethnic groups may have only been recently recognized. To improve CKD outcomes, enhancements in the identification of hypertension and dietary sodium intake assessments are needed including detailing ethnicities where hypertension prevalence and control are different. This will improve specific treatment of some groups with both hypertension and CKD. Hypertension alone or in combination with other primary renal conditions are significant factors in causing ESKD. Studies on control rates in Asian patients with CKD should aim to identify barriers to achieving goal blood pressures.

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REFERENCES

1. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290.

2. KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-S154.

3. Jinam TA, Kanzawa-Kiriyama H, Inoue I, Tokunaga K, Omoto K, Saitou N. Unique characteristics of the Ainu population in Northern Japan. J Hum Genet. 2015;60(10):565-571.

4. Subramanian S, Teo BW, Toh QC, et al. Spot urine tests in predicting 24-hour urine sodium excretion in Asian patients. J Ren Nutr. 2013;23(6):450-455.

5. Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China national nutrition and health survey 2002. Circulation. 2008;118(25):2679-2686.

6. Amano H, Kobayashi S, Terawaki H, Ogura M, Kawaguchi Y, Yokoo T. Measurement of daily sodium excretion in patients with chronic kidney disease; special reference to the difference between the amount measured from 24 h collected urine sample and the estimated amount from a spot urine. Ren Fail. 2018;40(1):238-242.

7. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet. 2012;379(9818):815-822.

8. Yan Z, Wang Y, Li S, et al. Hypertension control in adults with CKD in China: baseline results from the chinese cohort study of chronic kidney disease (C-STRIDE). Am J Hypertens. 2018;31(4):486-494.

9. Cai G, Chen X. Etiology, comorbidity and factors associated with renal function decline in chinese chronic kidney disease patients. J Am Soc Nephrology. 2011;22:183A-184A.

10. Tan M, He FJ, Wang C, MacGregor GA. Twenty-four-hour urinary sodium and potassium excretion in China: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8(14):e012923.

11. Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region Government. Report of Population Health Survey 2014/2015. 2017

12. Tang SC. CKD prevention: perspectives in Hong Kong. Nephrology. 2018;23(Suppl 4):72-75.

13. Ho YW, Chau KF, Choy BY, et al. Hong Kong renal registry report 2010. Hong Kong J Nephrol. 2010;12(2):81-98.

14. Anchala R, Kannuri NK, Pant H, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32(6):1170-1177.

15. Singh AK, Farag YM, Mittal BV, et al. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol. 2013;14:114.

16. Sekikawa A, Hayakawa T. Prevalence of hypertension, its awareness and control in adult population in Japan. J Hum Hypertens. 2004;18(12):911-912.

17. Imai E, Horio M, Watanabe T, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13(6):621-630.

18. Masakane I, Taniguchi M, Nakai S, et al. Annual dialysis data report 2016, JSDT renal data registry. Ren Replace Ther. 2018;4:45.