Clinical Studv On Influencing Factors And TCM Syndrome Types Of Protein Energy Wasting In Patients With Chronic Kidney Disease

Objective:To study the prevalence rate of Protein energy wasting(PEW)in patients with chronic kidney disease(CKD),determine distribution of the TCM syndrome types in patients with PEW,and explore the influencing factors of PEW in CKD patients from the perspective of traditional Chinese medicine and Western medicine,and then provide a theoretical basis for prevention and treatment of PEW in CKD patients.Methods:This study had collected patients with CKD who were seen in the nephrology department from June 2021 to December 2021,including demographic data,disease data,biochemical indicators,TCM data,diet,grip strength and etc,to analyze the prevalence rate of PEW,TCM syndrome types and syndrome distribution in CKD patients.And they were divided into PEW group and Non-PEW group according to the clinical diagnostic criteria of PEW,to analyze the differences in clinical indicators between the two groups,then Logistic regression was used to analyze the influencing factors of PEW.Content:(1)The influencing factors of PEW in CKD patients;(2)The influencing factors of PEW in maintenance hemodialysis(MHD)patients.Result:Part 1(1)The prevalence rate of PEW in CKD patients was 40.8%,of which the prevalence rate of dialysis patients was 58.5%,and the prevalence rate of non-dialysis patients was 24.1%.The prevalence of PEW in patients with CKD stages 1-5 was 7.5%,27.3%,22.6%,31.3%and 55.5%respectively.(2)Patients with PEW:Qi-yin deficiency syndrome and yin-yang deficiency syndrome were more common than other primary deficiency syndrome types,and damp-turbidity syndrome type was most common.And fatigue,lack of energy,aversion to cold and preference for warmth,soreness and weakness of waist and knees,oliguria,poor appetite were common TCM syndromes.(3)Compared with Non-PEW group,PEW group had age,chronic bedrest,dialysis,cardiovascular and cerebrovascular diseases,infections,Scr,Urea were higher than those in the non-PEW group;patients with self-care,HGS,BMI,RBC,Hb,ALB,Na,CL,TG were significantly lower than those in the Non-PEW group,and the difference was statistically significant(p<0.05).(4)Compared with Non-PEW group,PEW group had Qi-Yin deficiency syndrome,Yin-Yang deficiency syndrome,and dampness syndrome were higher than those in the non-PEW group;patients with spleen-kidney-qi deficiency syndrome and liver-kidney-Yin deficiency syndrome were significantly lower than those in the Non-PEW group,and the difference was statistically significant(p<0.05).(5)Binary logistic regression analysis showed that low BMI(<22 Kg/m2),inability to take care of oneself,low HGS,low Hb(<110 g/L),low serum ALB(<40 g/L),high Scr,advanced age,Qi-yin deficiency syndrome,intolerance of cold and cold limbs,poor appetite and oliguria were the risk factors of PEW in CKD patients.Part 2(1)The prevalence rate of PEW was 58.5%in MHD patients.(2)Patients with PEW:Qi-yin deficiency syndrome and yin-yang deficiency syndrome were more common than other primary deficiency syndrome types,and damp-turbidity syndrome type was most common.And fatigue,oliguri,aversion to cold and preference for warmth,lack of energy,poor appetite were common TCM syndromes.(3)Compared with Non-PEW group,PEW group had age,chronic bedrest,deep vein catheterization,type 2 diabetes,cardiovascular and cerebrovascular diseases,infections and anemia were higher than those in the Non-PEW group;patients with self-care,HGS,BMI,RBC,Hb,ALB,serum TP,Serum ALB,serum K,serum P,TG,Scr,UA were significantly lower than those in the Non-PEW group,and the difference was statistically significant(p<0.05).(4)Compared with Non-PEW group,PEW group had Yin-Yang deficiency syndrome,and dampness syndrome were higher than those in the non-PEW group;patients with liver-kidney-Yin deficiency syndrome and wind-dynamism syndrome were significantly lower than those in the Non-PEW group,and the difference was statistically significant(p<0.05).(5)Binary logistic regression analysis showed that low BMI(<22 Kg/m2),inability to take care of oneself,low HGS,low serum ALB(<38 g/L),infections,advanced age,intolerance of cold and cold limbs,poor appetite were the risk factors of PEW in MHD patients.Conclusions:1.CKD patients especially MHD patients have a high prevalence rate of PEW.Low BMI,inability to take care of themselves,low HGS,low Hb,low serum ALB,low TG,high Scr and infection are closely related to the occurrence of PEW.2.Patients with PEW in CKD and MHD,Qi and Yin deficiency syndrome type was the most common in primary deficiency syndromes,and dampness turbidity syndromes was the most common.Qi-yin deficiency syndrome type,advanced age,intolerance of cold and cold limbs,poor appetite and oliguria were closely related to the occurrence of PEW.