Efficacy of Yishen Jiangzhuo granules in the treatment of chronic kidney disease stages 3-4: a retrospective cohort study.

OBJECTIVE: To investigate the impact of Yishen Jiangzhuo granules on endpoint events in patients with chronic kidney disease (CKD) stages 3-4. METHODS: Based on real-world data, a retrospective analysis was conducted on patients with CKD stages 3-4 who were treated at a single hospital between January 2014 and December 2022. Patients taking Yishen Jiangzhuo granules > 6 months comprised the exposed group; others were non-exposed. The primary outcome was a composite kidney endpoint. Baseline characteristics were collected. Propensity score matching (PSM) balanced covariates. Multivariable Cox regression identified risk/protective factors. Dose-response and threshold effects were assessed using restricted cubic spline (RCS) curves. RESULTS: After PSM, 335 matched cases (87 exposed, 248 non-exposed) showed balanced baselines. Endpoint events differed significantly (38 vs174 events, P < 0.05). The estimated glomerular filtration rate (eGFR) slope was －3.88 mL·(1.73 m2·min·year)-1 in the exposed group. Multivariable Cox regression indicated lower endpoint risk in the exposed group [HR= 0.567, 95% CI (0.384, 0.838)]. The eGFR slope was the strongest predictor; hypoalbuminemia, elevated BUN, and elevated Scr were also independent risk factors (P < 0.05). A linear relationship existed between eGFR slope and endpoint events (P-nonlinear = 0.165), with a risk threshold at －3.6 mL·(1.73 m2·min·year)-1. CONCLUSION: Yishen Jiangzhuo granules may help stabilize renal function, slow the annual decline rate of eGFR, and reduce the risk of CKD progression in patients with stages 3-4 CKD. The eGFR slope is the most significant predictor of endpoint events, with a critical threshold at －3.6 mL·(1.73 m2·min·year)-1.