Effects of Shenkang for chronic kidney disease: a propensity score matched with network pharmacology analysis

Shenkang (SK) is a widely used formula for treating chronic kidney disease (CKD) since the 1990s. However, the associations of SK use with the long-term outcome among CKD patients have not been validated in real-world study. This single-center retrospective study included outpatients with CKD from 1 January 2013, to 31 December 2023. Patients who received SK were compared with control group after propensity score matching. A total of 2,463 patients met the inclusion criteria, with 546 matched pairs. The SK group had a significantly lower risk of end-stage renal disease (adjusted hazard ratios = 0.83, 95% confidence interval: 0.70-0.98; <i>p</i> = 0.030), and the cumulative event of end-stage renal disease was significantly lower in the SK group than in the control group (<i>p</i> = 0.027). The estimated glomerular fitration decline in SK group was also significantly slower than those in control group (<i>p</i> < 0.001). Subgroup analysis showed that SK had significant benefit in male patient. Network pharmacology was used to explore underlying mechanisms, which indicated that SK targets are enriched in epithelial cell proliferation, fluid shear stress, P13K-Akt, and MAPK signaling pathways. In summary, SK is a promising therapeutic option for improving clinical outcomes in CKD, potentially mediated by modulating the PI3K/AKT and MAPK signaling pathways, and modulating hemodynamics. However, further experimental validation both <i>in vivo</i> and <i>in vitro</i> is required.