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Occupational kidney disease among Chinese herbalists exposed to herbs containing aristolochic acids
  1. Hsiao-Yu Yang1,2,3,
  2. Jung-Der Wang3,4,5,
  3. Tsai-Chang Lo6,
  4. Pau-Chung Chen3,5
  1. 1Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
  2. 2School of Medicine, Tzu Chi University, Hualien, Taiwan
  3. 3Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
  4. 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  5. 5Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
  6. 6Public Health Bureau, Miaoli, Taiwan
  1. Correspondence to Dr Pau-Chung Chen, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No. 17 Xuzhou Road, Taipei 100, Taiwan; pchen{at}


Objective Many Chinese herbs contain aristolochic acids (ALAs) which are nephrotoxic and carcinogenic. The objective of this study was to identify whether exposure to herbs containing ALAs increased the risk of kidney disease among Chinese herbalists.

Methods A nested case–control study was carried out on 6538 Chinese herbalists registered between 1985 and 1998. All incident cases of chronic renal failure reported to the Database of Catastrophic Illness of the National Health Insurance Bureau between 1995 and 2000 were defined as the case group. Up to four controls without renal failure were randomly matched to each case by sex and year of birth. A structured questionnaire survey was administered between November and December 2002. The Mantel–Haenszel method and conditional logistic regression were used to estimate the risks.

Results 40 cases and 98 matched controls were included in the final analysis. After adjusting for age, frequent analgesic use, and habitual consumption of alcohol, fermented or smoked food, we found manufacturing and selling Chinese herbal medicine (OR 3.43, 95% CI 1.16 to 10.19), processing, selling or dispensing herbal medicines containing Fangji (OR 4.17, 95% CI 1.36 to 12.81), living in the workplace (OR 3.14, 95% CI 1.11 to 8.84) and a history of taking of herbal medicines containing Fangji (frequently or occasionally) (OR 5.42, 95% CI 1.18 to 24.96) were significantly associated with renal failure.

Conclusion Occupational exposure to and consumption of herbs containing ALAs increases the risk of renal failure in Chinese herbalists.

  • Chinese herbalist
  • aristolochic acid
  • chronic renal failure
  • epidemiology
  • health and safety
  • occupational health practice
  • renal
  • urological

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Committee of the National Taiwan University College of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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