Association of Danshen use with all-cause and cardiovascular mortality among patients with advanced chronic kidney disease

• Patients with advanced chronic kidney disease (CKD) are at higher risk of mortality. • Clinical studies often exclude advanced CKD patients. • This study specifically evaluated the effect of Danshen in this population. • Danshen use showed a trend toward lower cardiovascular mortality. • Danshen use was associated with reduced all-cause mortality. Chronic kidney disease (CKD) progression is associated with an increased mortality risk, primarily due to cardiovascular (CV) event, underscoring the need for targeted treatments to reduce CV risk and improve patient outcomes. Danshen, a traditional Chinese medicine known for its CV protective effects, is a potential therapy for improving outcomes in CKD patients. This study aims to evaluate the association between Danshen use and CV mortality, all-cause mortality, and end-stage renal disease (ESRD) risk in patients with advanced CKD. This retrospective study utilized the Chronic Kidney Disease Health Database, a disease-specific subset of the National Health Insurance Research Database in Taiwan. A total of 38,379 patients with advanced CKD were included between January 1, 2012, and December 31, 2015, with follow up until December 31, 2017. Patients were classified as Danshen users ( n = 1818) or non-users ( n = 36,561). Outcomes of interest were ESRD, CV mortality and all-cause mortality. Cumulative incidence was evaluated using Kaplan-Meier analysis. Cox proportional hazards models were applied to estimate hazard ratios (HRs), with adjustment for potential confounders. Stabilized inverse probability of treatment weighting – average treatment effect (IPTW-ATE) was applied to balance baseline characteristics between patient groups and to estimate IPTW-adjusted HRs. Danshen users showed a significant reduction in all-cause mortality (IPTW-adjusted HR, 0.80; 95 % confidence interval [CI], 0.71–0.91; P = 0.001) and a trend toward lower CV mortality (IPTW-adjusted HR, 0.82; 95 % CI, 0.68–1.00; P = 0.055), although the latter association was not statistically significant. However, there was a potential increase in ESRD risk among Danshen users (IPTW-adjusted subdistribution HR, 1.15; 95 % CI, 1.03–1.28; P = 0.010). Danshen use in advanced CKD patients was associated with a significant reduction in all-cause mortality and a trend toward lower CV mortality, but a potential increase in ESRD risk. These findings suggest that Danshen may provide CV and survival benefits in this high-risk population, but close monitoring of renal function is warranted.