| Purpose: To explore the association between hypomagnesemia and chronic kidney disease(CKD)progression,CKD-mineral and bone disorder(CKD-MBD),CKD with cardiovascular disease,CKD with malnutrition,etc.One of the purposes of this article is to analyze the distribution of TCM syndrome types in CKD stage 3-5 non-dialysis patients and another aim is summarize distribution characteristics of TCM syndrome types in CKD stage3-5 non-dialysis patients with hypomagnesemia.Methods: Using retrospective clinical research methods to analyze the data of general condition,clinical indicators,medical imaging and TCM syndrome data collected from 240 CKD stage 3-5 non-dialysis patients,met the inclusion criteria and did not meet the exclusion criteria,have complete information,hospitalized in the Department of Nephrology,the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2020 to December 2020.The association of hypomagnesemia with CKD and CKD-related comorbidities,the distribution of TCM syndrome types in CKD stage 3-5 non-dialysis patients and the distribution characteristics of TCM syndrome types in CKD stage 3-5non-dialysis patients with hypomagnesemia were statistically analyzed by SPSS software.Result:1.240 CKD stage 3-5 non-dialysis patients were included in this study,including 153 males and 87 females,aged 19-75 years,with an average age of(56.11±12.14)years.There are226 patients with a history of hypertension,accounting for 94.17%,121 patients with a history of diabetes,accounting for 50.42%,and 88 patients with a history of coronary heart disease,accounting for 36.67%.2.The incidence of hypomagnesemia in the study was 27.1%,and that in each stage of CKD was 27.8%(stage 3),20.3%(stage 4),and 32.6%(stage 5)respectively,with no significant difference(P>0.05).3.The patients with CKD stages 3-5(non-dialysis)were divided into the hypomagnesemia group and the control group according to the serum magnesium level.There was no significant difference in e GFR,Scr,BUN,UA,Cys-C,HCY,and 24-hour urine protein between the two groups at the same stage(all P>0.05).4.In CKD-MBD,correlation analysis shows that serum magnesium had a very weak positive correlation with Ca(P=0.015)and P(P=0.003).Comparatively,the corrected Ca level of the CKD stage 3 with hypomagnesemia group is higher than that of the control group(P=0.016),the Ca level of the CKD stage 4 with hypomagnesemia group is lower than that of the control group(P=0.011),and In patients with CKD stage 5,the levels of Ca and corrected Ca in the hypomagnesemia group are significantly lower than those in the control group(P<0.001,P<0.001),and the i PTH level is significantly higher than that in the control group(P=0.001).The incidence of hypocalcemia in the CKD stage 4 and 5 hypomagnesemia group is significantly higher than that in the control group(P=0.023,P<0.001).5.In the related links of CKD complicated with cardiovascular disease,serum magnesium is very weakly positively correlated with HDL-C(P=0.015),and weakly positively correlated with serum K level(P<0.001).Comparative studies also confirmed that in patients with CKD stages 3 and 5,the level of HDL-C in the hypomagnesemia group is significantly lower than that in the control group(P=0.029,P=0.044),and in CKD stages 4 and 5,the K level is significantly lower compared with the control group(P=0.007,P=0.016).Among 240 patients with CKD stage 3-5,the incidence of aortic sclerosis in the hypomagnesemia group is significantly higher than that in the control group(P=0.019),while there is no significant difference in the incidence of heart valve calcification between the two groups(P >0.05).6.In CKD with malnutrition,serum magnesium and ALB levels are weakly positively correlated(P=0.001);comparative studies also confirmed that in CKD stages 4 and 5,ALB levels in the hypomagnesemia group are significantly lower than those in the control group(P=0.016,P=0.001).7.Multivariate Logistic regression analysis showed that high i PTH,high HCY,low K,low HDL-C,and low serum albumin leve are risk factors for hypomagnesemia in patients with CKD stages 3-5.8.Among the 240 enrolled patients,qi deficiency of spleen and kidney syndrome is the most common(61.7%)in the deficiency syndrome,followed by yin deficiency of liver and kidney syndrome(13.3%),yang deficiency of spleen and kidney syndrome(12.5%),qi-yin deficiency of spleen and kidney syndrome(7.5%)and deficiency of both yin and yang syndrome(5.0%).In the excess syndrome,dampness-turbid syndrome(43.3%)and dampness-heat syndrome(41.3%)are common,followed by blood stasis syndrome(7.9%)and water-pathogen syndrome(4.2%).Turbidity-toxin syndrome is the least(3.3%).9.There is no significant difference in the distribution of the CKD stages 3-5 patients between the deficiency syndrome and the excess syndrome(all P>0.05).In CKD stages 3-5patients,the qi deficiency of spleen and kidney syndrome accounted for the highest proportion in the deficiency syndrome,the dampness-turbid syndrome and the dampness-heat syndrome accounted for the highest proportion of the excess syndrome and among CKD stages 3-5 patients,the damp-heat syndrome accounted for the largest proportion in the 3stage,and the damp-turbidity syndrome is the highest in the 4-5 stage.In CKD stage 5,the proportion of yang deficiency of spleen and kidney syndrome and water-pathogen syndrome increased significantly.10.Among 240 CKD stage 3-5 non-dialysis patients patients,there is no significant difference in the distribution of the deficiency syndrome and the excess syndrome between the hypomagnesemia group and the control group(both P>0.05).In contrast,the yin deficiency of liver and kidney syndrome in the hypomagnesemia group is much less than that in the control group(7.5%vs.15.6%),and the blood stasis syndrome is also much less than that in the control group(1.5%vs.10.4%).The 240 enrolled patients were grouped according to syndrome types,and there are significant differences in serum magnesium levels among patients with different the deficiency syndrome(P=0.014),and pairwise comparison showed that the serum magnesium level of patients with qi deficiency of spleen and kidney syndrome is significantly lower than that of yang deficiency of spleen and kidney syndrome and deficiency of both yin and yang syndrome(P=0.028,P=0.009),and the qi-yin deficiency of spleen and kidney syndrome is significantly lower than that of yang deficiency of spleen and kidney syndrome and deficiency of both yin and yang syndrome(P=0.030,P=0.008).However,no significant difference is found in the comparison of serum magnesium levels between patients with excess syndrome(P>0.05).Conclusion:1.In 240 CKD stage 3-5 non-dialysis patients,the incidence of hypomagnesemia was about 27.1%,and the incidence was similar in different periods.High parathyroid hormone,high blood homocysteine,low blood potassium,low high-density lipoprotein cholesterol,and low serum albumin are risk factors for hypomagnesemia.2.Hypomagnesemia can exacerbate CKD-MBD and contribute to the development and progression of CVD by contributing to abnormal lipid metabolism,arterial stiffness and calcification and hypokalemia,while also being associated with malnutrition.3.Among the 240 non-dialysis patients with CKD stages 3-5,qi deficiency of spleen and kidney syndrome was the most prevalent symptom(61.7%);The dampness-turbid syndrome and dampness-heat syndrome are more common in the excess syndrome,accounting for43.3% and 41.3%.However,the distribution of the deficiency syndrome and the excess syndrome is independent of CKD stage.4.Serum magnesium level is related to the deficiency syndrome,and lower magnesium level is significantly related to the qi deficiency of spleen and kidney syndrome and qi-yin deficiency of spleen and kidney syndrome. |
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