High prevalence of fenfluramine‐related aortic regurgitation in women with end‐stage renal disease secondary to Chinese herb nephropathy

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2003-05, Vol.18 (5), p.906-910
• Main Authors: Unger, Philippe, Nortier, Joëlle, Muniz Martinez, Marie‐Carmen, Plein, Danièle, Vandenbossche, Jean‐Luc, Vereerstraeten, Pierre, Vanherweghem, Jean‐Louis
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; aortic regurgitation; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Appetite Depressants - administration & dosage; Appetite Depressants - adverse effects; appetite suppressants; Biological and medical sciences; Case-Control Studies; Chinese herb nephropathy; Dose-Response Relationship, Drug; Drugs, Chinese Herbal - adverse effects; Echocardiography, Doppler; Emergency and intensive care: renal failure. Dialysis management; Female; fenfluramine; Fenfluramine - administration & dosage; Fenfluramine - adverse effects; Humans; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - etiology; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Risk Factors; Time Factors
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfg083

Background. Non‐controlled studies have noted a high prevalence of valvular regurgitation in patients with Chinese herb nephropathy; most of these patients had taken appetite suppressants. We aimed to determine the prevalence of valvular regurgitation and the role of appetite suppressants in patients with Chinese herb nephropathy. Methods. This case‐controlled echocardiographic study included 40 patients with end‐stage renal failure due to Chinese herb nephropathy and 37 age‐matched controls with end‐stage renal disease due to nephropathy of other origin. Quantification of cumulative doses of appetite suppressants was performed. Results. Aortic regurgitation was detected in 52.5% of patients with Chinese herb nephropathy, 72±1 months after stopping appetite suppressants, and in 21.6% of controls (P=0.009). No difference was found in the incidence of mitral or tricuspid regurgitation. A history of slimming medication was the only significant determinant for aortic regurgitation (P=0.009). Higher cumulative doses of Chinese herbs, (dex)fenfluramine and diethylpropion were observed in patients with Chinese herb nephropathy with, when compared to those without, aortic regurgitation. The dose–response relationship between the cumulative dose of drugs and the presence of aortic regurgitation was significant for fenfluramine only (chi‐square=5.16, P=0.024). Conclusions. Six years after stopping appetite suppressants, aortic regurgitation remains highly prevalent among patients with end‐stage Chinese herb nephropathy. The dose‐related association with fenfluramine intake strongly confirms a determinant pathogenic role of anorectic drugs.