Analysis Of Related Factors Of Renal Anemia In CKD Stages 3-5(Non-dialysis)and Summarization Of Professor Sun Wei’s Prescription Characteristics

Objectives:This study revealed the connection between anemia and the progress of CKD and explored the characteristics of professor Sun Wei’s prescription to guide TCM treatment and control the progress of the disease.Methods:From January 2018 to December 2020,A total of 219 patients with anemia in CKD3-5(non-dialysis)with 390 prescriptions were collected from the outpatient department of Professor Sun Wei in Jiangsu Privince Hospital of Chinese Medicine.The patients were divided into mild anemia group(172 patients)and moderate to severe anemia group(47 patients)according to their hemoglobin levels.The factors that influence renal anemia and the relationship between renal anemia and renal failure were determined according to the single-factor and multi-factor analysis of patients’ basic and biochemical data.The general information of patients and the corresponding prescriptions were entered into excel to establish a standardized processing database.Then the information such as drug composition and classification,and use frequencies was retrieved with data mining.Cluster analysis of high-frequency drugs of professor Sun’s core prescription,key combination was performed using SPSS to study the medication characteristics and academic ideas of Professor Sun on the renal anemia treatment.Results:1.Among the 219 patients ranged from 19 to 80 years old,117 were males(53.4%)and 102 were females(46.6%).The age of onset was mostly among 50 to 69.83 patients(37.9%)were in CKD 3,69(31.5%)in CKD 4,and 67(30.6%)in CKD 5.The primary diseases of the 219 patients were as follows:105 cases(47.9%)of chronic glomerulonephritis(no renal puncture),28 cases(12.8%)of diabetic nephropathy,26 cases(11.9%)of IgA nephropathy,18 cases(8.2%)of hypertensive nephropathy,13 cases(5.9%)of polycystic kidney disease,7 cases(3.2%)of uric acid nephropathy,5 cases(2.3%)of nephrotic syndrome,and 17 cases(7.8%)of others.172 cases developed mild anemia(79 of CKD 3,59 of CKD 4 and 34 of CKD 5)and 47 cases had moderate to severe anemia(4 of CKD 3,10 of CKD 4,33 of CKD 5).2.Univariate analysis of the severities of anemia in CKD patients:(1)Significant difference in CKD stages was observed between mild anemia group and moderate to severe anemia group(P<0.05).However there were no significant differences in gender,age and primary diseases between the two groups(P>0.05).(2)The levels of blood calcium,eGFR,serum albumin,total cholesterol,and triglycerides in the mild anemia group were higher than those in the moderate to severe group,while the levels of serum creatinine,phosphorus and urea nitrogen in the mild anemia group were lower than those in the moderate to severe group(P<0.05).(3)There was no significant difference in uric acid and platelet count between the two groups(P>0.05).3.Multivariate logistic regression analysis on anemia severity revealed that the serum albumin,eGFR,and total cholesterol were independent influencing factors of the severity of anemia(P<0.05),while the blood calcium,blood phosphorus,and urea nitrogen had no obvious effect on the severity of anemia(P>0.05).4.The hemoglobin,total cholesterol,blood calcium,and blood phosphorus were related to eGFR(P<0.05).5.A total of 146 Chinese herbs was used in professor Sun’s prescriptions.The commonly used herbs(defined as the cumulative frequency reaching 50%)were Radix Astragali,Cortex Eucommiae,Rhizoma Atractylodis Macrocephalae,Folium Pyrrosiae,Rhizoma Polygoni Cuspidati,Caulis Perillae,Radix Codonopsis,Radix Curcumae,Dioscoreae Nipponicae Rhizoma,Rhizoma Smilacis Glabrae,Radix Angelicae Sinensis,Serissae Herba,Euonymi Lignum Suberalatum,Herba Oldenlandiae.These herbs mainly had warm and mild medicine properties.In contrast,herbs with severe cold or severe heat properties had the lowest usage.The flavor of the herbs are mostly bitter,sweet,and acrid.The meridian tropisms are mainly liver,spleen,lung and kidney.The classifications are mainly toinfying medicinal,damp-draining diuretic,blood-activating and stasis-resolving medicinal and heat-clearing medicinal.The cluster analysis revealed 4 groups of core prescriptions,and 11 groups of commonly used couplet medicinals and drug combinations.Conclusions:1.In this study,chronic glomerulonephritis,diabetic nephropathy and IgA nephropathy are the top three primary diseases in patients with anemia in CKD stage 3-5(non-dialysis).As the renal damage was exacerbated,the progress of CKD aggravated the severity of anemia.2.CKD staging,blood calcium,blood phosphorus,blood creatinine,urea nitrogen,eGFR,serum albumin,total cholesterol,triglycerides are related to the severity of anemia.Serum albumin,eGFR,and total cholesterol are independent influencing factors of the severity of anemia.3.Hemoglobin,total cholesterol,blood calcium,and blood phosphorus are related to eGFR values.4.This study conducted data mining on Professor Sun’s prescriptions for the treatment of renal anemia,elucidating Professor Sun’s theory on the treatment of renal anemia"Yishenqingli,Heluoxiezhuo" and the concept of " Treat the kidneys to treat anemia",which also reflects the characteristic of Professor Sun’s "peaceful and light"medication.