Analysis Of Impact Factors Of Renal Progression On Chronic Kidney Diseaseâ…£

Objectives:We discuss the impact factors of renal function progression in the patients with CKD 4 stage in Hubei province and analyze the relationship between the renal function progression and the TCM. Thus we can provide theoretical basis for clinical prevention and treatment which combine traditional Chinese and western medicine for patients who was end stage renal disease from the early CKD.Methods:The study included 65 patients of CKD 4th stage who was at outpatient follow-up in Hubei Chinese medicine hospital during February 1, 2012 to January 31,2015.At first,we collected the baseline data, visited follow-up until some of them accessed outcome event(the e GFR double or e GFR<15 ml/min per 1.73m2 or to start dialysis or death).We consider the censored data as did not appear the outcome event in the end of the study. 65 cases divided into renal function progression group and non-progression group. Recorded patients’ general information(including gender, age, and body mass index BMI, etc), Serum creatinine,haemoglobin(HB),serum calcium, serum phosphorus,total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), fasting blood glucose(FBG), glycosylated hemoglobin(Hb A1c),24 hurinary protein,parathyroid hormone(i PTH),the prevalence of carotid artery atheromatous plaque and abdominal aortic calcification and the TCM syndrome. COX-regression model is applied to analysis risk factors and protest factors of patients of CKD 4thstage.Results:1. There were 65 cases of patients with CKD 4th stage, including 32 males(49.2%)and 33 females(50.8%).The mean age of the study population was 58.58±11.66 years old. There was no significant difference in age and sex between renal function progression group and non-progression group.2. The e GFR and serum calcium level at progression group was significant decrease than those non-progression group in CKD 4th stage(P<0.001, P=0.001). On the contrary, the 24 h urinary protein and IPTH level at progression group was rise than those non-progression group in the patients of CKDⅣ(P=0.020,P<0.001).3. In the deficiency syndrome type, spleen and kidney qi deficiency syndrome was the first, accounting for 44.6%, deficiency of spleen and kidney yang and deficiency of both qi and yin syndrome were both account for 27.7%.The deficiency of both qi and yin syndrome was the most in progression group, the spleen and kidney qi deficiency was the most in non-progression group. In real evil signs, the wet muddy、the damp heat and the blood stasis accounted 36.9%、35.4%、27.7%,respectively.The emergence of the blood stasis was the highest in progression group, the wet muddy was the most in non-progression group. The progress of renal function was correlated with deficiency of both qi and yin syndrome and blood stasis.4. The average survival rate of renal was 53.8%, among which 6-month survival was 96.2%,1-year survival was 83.0%,and 2-year survival was 60.2%.5. COX single factor regression analysis shows that elevated triglycerides, hypocalcemia, hyperthyroidism and the spleen qi and Yin deficiency syndrome could endanger the patients of CKD4 into the end point events. On the other hand, the age, gender, BMI, carotid plaques, abdominal aortic calcification and the empirical has no obvious correlation with renal function in patients with progress.6.A multivariate COX proportional hazards regression analysis via enter methods shows that risk factors correspond with end point event in patients of CKD 4th stage was male(b>0,HR>1) with the HR was 4.249(95%CI:1.35-13.41),and the spleen qi and Yin deficiency syndrome(b<0,HR<1) was the protest factor with the HR was 0.126(95%CI:0.04-0.44).7.the step forward LR methods indicated that male and hypocalcemia(b>0,HR>1) were risk factors relate to the progression of renal function with the HR was 4.210(95%CI:1.43-12.40) 、5.740(95%CI:1.61-20.53),respectively. The spleen qi and Yin deficiency syndrome(b<0, HR<1) was the protest factor in patients of CKD 4 with the HR was 0.132(95%CI:0.04-0.46).The risk of male into the endpoint was 4.210 times than that of female patients with CKD 4, and the risk of hypocalcemia was increase 4.740 times than patients with normal serum calcium with the risk of end point events.Conclusions:1. Patients who is male or hypocalcemia could aggravate CKD stage 4 progression and endpoint events occurred.2. The proportion of spleen and kidney deficiency syndrome in patients with CKD 4 was the most. Patients with qi and Yin deficiency syndrome may be the most vulnerable to the deterioration of renal function, patients with spleen and kidney qi deficiency syndrome could slow down the ESRD occurred.3. The proportion of wet material certificate in patients with CKD4 was the most. Patients with blood stasis syndrome may be the most vulnerable to the deterioration of renal function, patients with wet material certificate could slow down the ESRD occurred.