Effect Of Yishen Jiangzhu Granules Combined With Basic Therapy On Anemia Index And Hepcidin In Patients With CKD3 And 4 Renal Anemia

ObjectiveTo observe the effect of Yishen Jiangzhu Granules combined with basic therapy on anemia index and hepcidin in patients with CKD3 and 4 renal anemia,analyze the correlation of hepcidin,and discuss the actual changes of serum hepcidin in the process of clinical treatment of renal anemia.Methods70 cases of CKD3,4 patients with inpatient or outpatient department of the Department of Nephrology in our hospital met the KDIGO chronic kidney disease diagnosis and staging criteria in 2012,and dialectically confirmed as spleen and kidney qi deficiency.During the period,3 cases were excluded(1 case was not reviewed on time,2 cases were stopped by Chinese medicine,and removed)and 67 cases were completed.Another 30 healthy subjects were selected as the normal group during the same period.Serum hepcidin was measured by ABC-ELISE assay,and serum creatinine(Scr),urea nitrogen(BUN),hypersensitive C-reactive protein(hs-CRP)were detected by automatic biochemical analyzer(BECKMAN-C800).Serum ferritin(SF)was measured by immunoradiometric assay.Red blood cell(RBC),hemoglobin(Hb)and hematocrit(HCT)was detected by hematology analyzer.Calculate glomerular filtration rate(eGFR)using the CKD-EPI formula,and lastly statistical analysis of the correlation between serum hepcidin and various indicators.Results(1)Compared with CKD3 stage,CKD stage 4 renal anemia was heavier before treatment,RBC,Hb,HCT decreased,hepcidin level increased,SF and hsCRP increased,the difference was statistically significant(P<0.05).(2)After the combination of Yishen Jiangzhuo Granules and basic treatment,CKD3 and 4 renal function indexes(eGFR,Scr,BUN)were significantly improved(P<0.01),and anemia indicators(RBC,Hb,HCT)were improved(P<0.01),and the improvement of CKD stage 3 anemia index was sig-nificantly higher than that of CKD stage 4(P<0.05).(3)There was no change in serum hepcidin levels in CKD3 and 4 after treatment(P>0.05).(4)Correlation analysis results: Serum hepcidin was negatively correlated with eGFR(r=-0.429,P<0.01),RBC(r=-0.306,P<0.05),HCT(r=-0.296,P<0.05)and Hb(r=-0.247,P<0.05).Serum hepcidin with hsCRP(r=0.575,P<0.01),Scr(r=0.434,P<0.01),BUN(r=0.273,P<0.05)and SF(r=0.262,P<0.05)showed a positive correlation.Multiple linear regression analysis showed that hsCRP and Scr were closely related to the increase of hepcidin in patients with CKD3 and 4 renal anemia(P<0.01),and hsCRP was the most important factor.Conclusions(1)Yishen Jiangzhuo Granules combined with basic treatment can delay the progression of renal function,improve the levels of RBC,Hb and HCT in patients with CKD3 and 4 renal anemia,and have certain curative effect on improving renal anemia.(2)The anemia index of patients with CKD3 and stage 4 renal anemia improved by Yishen Jiangzhuo Granules combined with basic treatment,but did not affect the level of hepcidin.There was no change in the level of hepcidin before and after treatment,which may be related to short observation time,renal function and inflammation.