The Body Composition And TCM Syndrome Of Patients With Chronic Kidney Disease Under Different Physical Activity

ObjectiveIn this study,the body composition analyzer was used to analyze the body composition and the GT3X accelerometer was used to measure the physical activity of patients with non-dialysis chronic kidney disease(CKD),aiming to explore the related factors that may affect the body composition.Besides,the distribution of TCM syndromes of patients under different levels of physical activity was described,to provide a theory for scientifically guiding patients’ physical activity in the future.MethodsThis study was based on the PEAKING cohort established in Guangdong Provincial Hospital of Traditional Chinese Medicine in February 2017,which included patients with non-dialysis CKD diagnosed according to the KDIGO guidelines,and baseline characteristics were collected,such as age,gender,CKD staging,comorbidities,and TCM syndromes,etc.On the day of the enrollment,patients were required to wear an accelerometer for 9 consecutive days to measure their daily physical activity,and to collect the body composition data within 180 days before and after the enrollment.Stata 15.0 statistical software was used to analyze the possible influencing factors of body composition of patients with non-dialysis CKD,and the difference in body composition under different physical activity levels and different CKD staging groups.After clarifying the distribution of TCM syndromes,the differences of TCM syndrome of patients under different physical activities were analyzed.Two independent samples t-test or Wilcoxon rank-sum test was conducted according to whether the measurement data conformed to the normal distribution or not.ResultsA total of 104 non-dialysis CKD patients were enrolled in this study.The median age of the patients was 49.65 years old at the time of enrollment.There were 54 males and 50 females.There were 0 patients with low-level physical activity,42 patients with moderate physical activity,and 62 high-level physical activity patients.There were 26,27,25,13,13 patients in CKD stage 1 to 5,respectively.The top 3 comorbidities were hypertension,gastrointestinal diseases,hepatobiliary and pancreatic spleen diseases.The top three drugs used most were antihypertensive,acid-base balance drugs,and uric acid lowering drugs.There were no significant differences in the age,gender,smoking,and drinking status of the population,the number of patients in different CKD stages,comorbidities,and drug use in the moderate and high-level physical activity groups.Dividing patients with CKD 1 to 2 stage into one group and CKD in 3 to 5 stage into another group,the results suggested that the difference of total body water,intracellular water,extracellular water,protein,minerals,and skeletal muscle were not statistically significant in two groups,but the body fat mass in the two groups was significantly different(P<0.05),in other words,the body fat of patients with CKD 1 to 2 stage was significantly greater than that of 3 to 5 stage.There was no statistically significant difference in the distribution of total body water,intracellular water,extracellular water,protein,minerals,skeletal muscle,and body fat in the moderate and high-level physical activity groups.Variables with a P value less than 0.2 in the univariate analysis,the CKD groups,physical activity,age,and gender were included as independent variables in the multiple linear regression model.The results showed that gender and taking antihypertensive drugs could affect the total body water,intracellular water,extracellular water,protein,minerals,and skeletal muscle.Besides,the Charlson comorbidity index was also an important factor affecting minerals.The main influencing factor of body fat was the use of antihypertensive drugs,with P values less than 0.05.Compared with men,women’s total body water,intracellular water,extracellular water,protein,minerals,and skeletal muscle mass were significantly less.Compared with patients who had not taken antihypertensive drugs,the ones taking antihypertensive drugs had significantly more total body water,intracellular water,extracellular water,protein,minerals,skeletal muscle,and body fat.As the Charlson comorbidity index increased,the mineral mass decreased.The main TCM syndromes were spleen and kidney qi insufficiency,followed by liver and kidney yin insufficiency,spleen and kidney yang insufficiency,and qi and yin insufficiency.There was no significant difference in the distribution of main TCM syndromes in different stages of CKD and different levels of physical activity,while x2 were 4.16 and 2.47.respectively,and the P values were 0.244 and 0.481,respectively.The main concomitant TCM syndromes of traditional Chinese medicine were damp-heat syndrome,followed by damp turbidity syndrome,blood stasis syndrome,heat toxin syndrome,and wind movement syndrome.ConclusionThe study suggested that the body composition of patients with non-dialysis CKD was not affected by the severity of CKD,while gender,drug use,and Charlson comorbidity index were factors affecting body composition.Women’s body composition,except for body fat,was less than that of men.The use of drugs such as antihypertensive drugs had a positive effect on the body composition of patients with non-dialysis CKD.The Charlson comorbidity index could also hurt minerals.Therefore,it is necessary to pay attention to the comorbidities of patients with non-dialysis CKD,prescribe appropriate drugs and practice therapeutic intervention.The difference in body composition between moderate and high levels of physical activity was not statistically significant.However,because of the lack of comparison of people with low-level physical activity,it was temporarily impossible to understand the specific impact of physical activity or the minimum threshold of physical activity that could affect the body composition in patients with non-dialysis CKD.It still needs further research and proof of big sample data.The TCM syndromes of patients with non-dialysis CKD conformed to people’s constitution characteristics in Lingnan.Focusing on the relationship between TCM syndromes and the physical activity of CKD non-dialysis patients will help enrich the TCM dialectical system.