| ObjectiveTo explore the two-year-prognosis of patients with chronic kidney disease(CKD)who underwent continuous ambulatory peritoneal dialysis(CAPD)treatment by observing the correlation between traditional Chinese medicine(TCM)syndromes before CAPD and endpoint events within 2 years.To explore the incidence of long-term complications of different TCM syndromes and judge the prognosis of CAPD patients with different TCM syndromes by observing the occurrence of complications in patients who didn’t occur two-year-endpoint event.It also provides a clinical basis for TCM treatment to improve the prognosis of CAPD patients.In addition,the laboratory indicators of patients before dialysis were used to explore the risk factors affecting the occurrence of end points and various complications in patients with CKD within 2 years after CAPD treatment.MethodsData collected from patients with chronic kidney disease who attended the First Clinical School of Guangzhou University of Traditional Chinese Medicine and received peritoneal dialysis(PD)for the first time between January 1,2010 and January 1,2019.Draw the distribution of different TCM syndrome types through differentiation of symptoms and signs.Follow-up patients’ endpoint events and the occurrence of complications.By comparing the indicators of CAPD patients with and without two-yearendpoint events or complications,to explore the correlation with TCM syndromes as well as the risk factors for two-year-endpoint events and various complications after dialysis.Results1)In CAPD patients,the origin deficiency syndromes of spleen and kidney qi deficiency,spleen and kidney yang deficiency,qi and yin deficiency,liver and kidney yin deficiency and yin and yang deficiency accounted for 43.7%、25.2%、10.4%、12.6%、8.1%respectively,while the superficiality excess syndromes of dampness and turbidity,damp-heat,water-qi,blood stasis and turbid toxin accounted for 35.6%、14.8%、16.3%、18.5%、14.8%respectively.Among patients with spleen and kidney qi deficiency syndrome,patients with dampness and turbidity syndrome accounted for the largest proportion,accounting for 60.4%.Among patients with spleen and kidney yang deficiency syndrome,patients with water-qi syndrome accounted for the largest proportion,accounting for 54.5%.Among patients with qi and yin deficiency syndrome,patients with blood stasis and damp-heat syndrome accounted for the largest proportion,accounting for 20.0%.Among patients with liver and kidney yin deficiency syndrome,patients with damp-heat syndrome accounted for the largest proportion,accounting for 20.0%.Among patients with yin and yang deficiency syndrome,patients with turbid toxin syndrome accounted for the largest proportion,accounting for 20.0%.2)The incidence of 2-year-endpoint events was 28.1%,and peritonitis leading to the conversion of CAPD patients to HD treatment was the main reason for the endpoint events,accounting for 34.2%.Males,diabetes,switching from HD to PD treatment,being infected in the first year of PD,higher total red blood cell and hemoglobin levels and lower PTH levels are more likely to occur two-year-endpoint events(P<0.05).Binary Logistic regression analysis concluded that high levels of red blood cells count(OR=3.175)and glycosylated hemoglobin(OR=2.316)are the risk factors for the two-year-endpoint event(P<0.05).Qi and yin deficiency[RR(95%CI)=3.833(1.440-10.204)]and yin and yang deficiency[RR(95%CI)=3.640(1.19611.076)]are at higher risk of two-year-endpoint event than the other origin deficiency syndromes.Turbid toxin syndrome[RR(95%CI)=1.784(1.0013.180)]is at higher risk of two-year-endpoint event than the other superficiality excess syndromes.3)The incidence of infectious complications is 61.9%,while peritonitis is the main type,accounting for 37.1%.Patients with longer dialysis age,cardiovascular disease before PD,lower levels of total cholesterol,apolipoprotein A,and low-density lipoprotein,and higher levels of systolic blood pressure and BNP are more likely to be infected(P<0.05);Binary Logistic regression analysis shows that high level of cholesterol before PD(OR=0.631)is a protective factor for infection,while cardiovascular disease before PD(OR=3.891)is a risk factor(P<0.05).There is no significant difference in the infection rate of each type of origin deficiency syndrome.The infection rate of damp-heat syndrome is higher than other superficiality excess syndromes[RR(95%CI)=1.482(1.1181.965)].4)The incidence of non-infectious complications is 67.0%,while the abnormal heart function is the main type,accounting for 32.0%.Patients with low levels of total red blood cell count,HGB,and ALB are more likely to have non-infectious complications(P<0.05);Binary Logistic regression analysis shows that low levels of red blood cell count(OR=0.229)and ALB(0R=0.831)as well as taking β-blockers(OR=5.209)before PD will increase the risk of non-infectious complications(P<0.05).Patients with spleen and kidney qi deficiency[RR(95%CI)=2.926(1.001-8.553)]have a higher risk of gastrointestinal diseases than other origin deficiency syndromes.Waterqi syndrome[RR(95%CI)=2.508(1.243-5.059)]has a higher risk of vascular disease than other superficiality excess syndrome.Turbid toxin syndrome[RR(95%CI)=1.824(1.072-3.105)]has a higher risk of diseases caused by mineral metabolism disorders than other superficiality excess syndrome.Conclusion1)The main origin deficiency syndrome before PD is spleen and kidney qi deficiency.The main superficiality excess syndrome before PD is dampness and turbidity.Patients with spleen and kidney qi deficiency are often mixed with dampness and turbidity,patients with spleen and kidney yang deficiency are often mixed with water-qi syndrome,patients with qi and yin deficiency are often mixed with blood stasis and damp-heat syndrome,patients with liver and kidney yin deficiency are often mixed with dampheat syndrome,patients with yin and yang deficiency often mixed with turbid toxin syndrome.2)The incidence of 2-year-endpoint events was 28.1%,and peritonitis leading to the conversion of CAPD patients to HD treatment was the main reason for the endpoint events.High levels of red blood cells count(OR=3.175)and glycosylated hemoglobin(OR=2.316)are the risk factors for the two-year-endpoint event(P<0.05).Qi and yin deficiency(RR=3.833)and yin and yang deficiency(RR=3.640)are at higher risk of two-year-endpoint event than the other origin deficiency syndromes.Turbid toxin syndrome(RR=1.784)is at higher risk of two-year-endpoint event than the other superficiality excess syndromes.3)The incidence of infectious complications is 61.9%,while peritonitis is the main type.High level of cholesterol before PD(OR=0.631)is a protective factor for infection,while cardiovascular disease before PD(OR=3.891)is a risk factor(P<0.05).There is no significant difference in the infection rate of each type of origin deficiency syndrome.The dampheat syndrome is prone to infected(RR=1.482).4)The incidence of non-infectious complications is 67.0%,while the abnormal heart function is the main type.Low levels of red blood cell count(0R=0.229)and ALB(0R=0.831)as well as taking β-blockers(OR=5.209)before PD will increase the risk of non-infectious complications(P<0.05).Turbid toxin syndrome has a higher risk of diseases caused by mineral metabolism disorders than other superficiality excess syndrome.These results indicate that patients with spleen and kidney qi deficiency is prone to gastrointestinal diseases(RR=2.926),patients with water-qi syndrome is more prone to vascular disease(RR=2.508),and patients with turbid toxin syndrome is more prone to diseases caused by mineral metabolism disorders(RR=1.824). |
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