The Study Of Exploring The TCM Syndrome Characteristics Of Maintenance Hemodialysis Patients With Hypertension

ObjectiveThis study is to know the clinical features and the distribution of traditional Chinese medicine(TCM)syndromes of maintenance hemodialysis(MHD)patients with hypertension in our Dialysis Center.Probe the risk factors of hemodialysis-associated hypertension,the correlation rules between hemodialysis-associated hypertension and TCM syndromes and the deepen clinical awareness of hemodialysis-associated hypertension.This study aims to provide new TCM treatment ideas for hemodialysis-associated hypertension,give full play to the advantages of TCM treatment,and improve the prognosis of MHD patients.MethodsAnalyze the collected clinical data of MHD patients retrospectively.Contrast the clinical indicators from different blood pressure groups.Analyze the risk factors of MHD patients being complicated hypertension by using logistic regression analysis.Discriminate the TCM syndromes by referring the standards of TCM syndromes of chronic kidney disease.Contrast the clinical indicators from different TCM syndromes.Analyze the correlation between TCM syndromes and hemodialysis-associated hypertension.Results1.General information:280 cases were collected totally,with 174 male cases(62.1%)and 106 female cases(37.9%).Of the 280 MHD patients,the first protopathy is primary glomerulonephritis(n=119,42.5%),followed by 84 cases of diabetic nephropathy(30.0%),37 cases of hypertensive renal injury(13.2%);56(20%)patients receive dialysis twice a week,224 patients(80%)3 times a week;97(34.6%)patients receive hemodialysis filtration occasionally;181 patients meet the Kt/V standard,with the standardized rate of 64.6%.2.A general analysis of features of MHD patients being complicated hypertension:of the 280 MHD patients,240(85.7%)have interdialytic hypertension,61(25.4%)interdialytic hypertension individuals meet the blood pressure standard before receiving hemodialysis while 179 failed,101(36.1%)MHD patients meet the blood pressure standard before receiving hemodialysis totally;with 64 cases(22.9%)have intradialytic hypertension.217 patients with interdialytic hypertension take antihypertensive drugs,of which 184(84.8%)take CCB,169(77.9%)take ACEI/ARB,135(62.2%)take P RB,and 66(30.4%)take a RB;39 cases(18%)receive quadruple medication,70 cases(32.3%)receive triple medication,68 cases(31.3%)receive double medication,and 40 cases(18.4%)receive single medication.It suggests that ACEI/ARB treatment and double antihypertensive medication have the highest standardized rate.3.Analysis of related factors in MHD patients with interdialytic hypertension:the differentiation in weight gain,weight gain rate,Kt/V standardized rate,EPO doses,serum sodium and MMP-9 between the pre-hemodialysis blood pressure standardized group and substandard group is of statistical significance.Logistic regression analysis shows that weight gain rate,EPO doses,serum sodium and MMP-9 are independent risk factors that lead to interdialytic blood pressure disqualification while Kt/V standard is the protective factor.4.Analysis of related factors of hypertension in MHD patients with intradialytic hypertension:the differentiation in interdialytic blood pressure standardized rate,serum sodium and rennin between the intradialytic hypertension and non-hypertension group is of statistical significance.Logistic regression analysis shows that interdialytic blood pressure standardized rate,renin and MMP-9 are independent risk factors which lead to intradialytic hypertension.5.Effect of dialysis on blood pressure,renin and MMP-9:In two groups that different dialysis frequency,the differentiation in interdialytic systolic pressure,MMP-9,prevalence rate of intradialytic hypertension is of statistical significance.The patients receive hemodialysis twice a week have a higher interdialytic systolic pressure and MMP-9 level.The patients receive hemodialysis three times a week have a higher prevalence rate of intradialytic hypertension.The differentiation in renin level is of no statistical significance.In two groups that different dialysis treatments,the differentiation in renin level is of statistical significance.The patients receive HD+HDF have a higher renin level.The differentiation in interdialytic systolic pressure,MMP-9,prevalence rate of intradialytic hypertension is of no statistical significance.6.The TCM symptoms,tongue pictures and pulse of MHD patients:Of 280 MHD patients,the most common symptom is fatigue(85%),uropenia(80.4%),body heaviness and languid(66.4%),breathe shortness and speaking laziness(61.4%),thirsty(60%),poor sleeping(59.6%),pruritus(56.4%),sallow complexion(48.2%),gloomy complexion(45%),dizziness and waist-knees soreness and weakness(39.6%).The most common tongue pictures are pale tongue,white tongue fur and thick tongue fur.The relatively common seen pulse conditions are string pulse,rapid pulse,stringer pulse,deep pulse and slippery pulse.7.Distributions of TCM syndromes:The deficiency syndrome could be divided into 5 types.Of 280 patients,most patients have Qi deficiency of spleen and kidney syndrome which make up for 40.7%(n=114),followed by deficiency of both Qi and Yin syndrome of 28.6%(n=80),Yin deficiency of liver and kidney syndrome of 17.1%(n=48),Yang deficiency of spleen and kidney syndrome of 7.1%(n=20),least patients have deficiency of both Yin and Yang syndrome of only 6.4%(n=18).The sthenia syndrome could be divided into 5 types,the most commonly seen is blood-stasis syndrome(n=89,31.8%),followed by damp-heat syndrome(n=87,31.1%),damp-turbidity syndrome(n=69,24.6%),water-vapor syndrome(n=26,9.3%),and the least seen wind-stirring syndrome(n=9,3.2%).8.Correlation study of interdialytic hypertension in MHD patients and its TCM syndromes:In deficiency syndrome,the most common syndrome occurred in interdialytic hypertensive patients is Qi deficiency of spleen and kidney syndrome,followed by Yin deficiency of liver and kidney syndrome,deficiency of both Qi and Yin syndrome,deficiency of both Yin and Yang syndrome,Yang deficiency of spleen and kidney syndrome,the differentiation in interdialytic blood pressure standardization of different deficiency syndromes suggests no statistical significance.In sthenia syndrome,the most common syndrome in interdialytic hypertensive patients are damp-turbidity syndrome and damp-heat syndrome,followed by blood-stasis syndrome,water-vapor syndrome,wind-stirring syndrome,of which the damp-turbidity syndrome has the lowest standardized rate(20.3%),and the differentiation in interdialytic blood pressure standardization of different sthenia syndromes is of statistical significance.In deficiency-sthenia syndrome,differentiation of interdialytic blood pressure standardization in different sthenia syndrome based on Qi deficiency of spleen and kidney syndrome is of statistical significance,of which the interdialytic blood pressure standardized rate of spleen-kidney deficiency with damp-turbidity syndrome is significantly lower than that of other syndromes(7.7%).9.Correlation study of intradialytic hypertension in MHD patients and its TCM syndromes:In deficiency syndrome,the most common syndrome occurred in intradialytic hypertensive patients is Qi deficiency of spleen and kidney syndrome,followed by deficiency of both Qi and Yin syndrome,Yin deficiency of liver and kidney syndrome,deficiency of both Yin and Yang syndrome,Yang deficiency of spleen and kidney syndrome.In sthenia syndrome,the most common syndrome occurred in intradialytic hypertensive patients are blood-stasis syndrome and damp-heat syndrome,followed by damp-turbidity syndrome,water-vapor syndrome,wind-stirring syndrome.The differentiation in intradialytic hypertension prevalence rates of different sthenia syndromes and deficiency syndromes suggests no statistical significance.In deficiency-sthenia syndrome,the most commonly seen syndrome occurred in intradialytic hypertensive patients is Qi deficiency of spleen and kidney with blood-stasis syndrome(11 cases),followed by deficiency of both Qi and Yin with blood-stasis syndrome(9 cases),deficiency of both Qi and Yin with damp-heat syndrome(9 cases),Qi deficiency of spleen and kidney with damp-heat syndrome(6 cases),deficiency of both Qi and Yin with damp-turbidity syndrome(6 cases),Yin deficiency of liver and kidney with damp-heat syndrome(6 cases),and the differentiation in prevalence rates of these syndromes suggests no statistical significance.10.Correlation study of TCM syndromes and its clinical indexes:In different deficiency syndrome groups,only the differentiation in PTH of different groups has its statistical significance,and patients with Yang deficiency of spleen and kidney syndrome have a lower PTH level.Of different sthenia syndrome groups,the differentiation in gender,pre-hemodialysis systolic pressure,MAP difference during hemodialysis,MAP difference after hemodialysis,MMP-9 of different groups has statistical significance.Damp-turbidity syndrome has the highest proportion of male patients(72.5%)while wind-stirring syndrome has the lowest proportion of male patients(22.2%).Patients with water-vapor syndrome have the highest MMP-9 level,and patients with damp-turbidity syndrome have a relatively higher pre-hemodialysis systolic pressure and MMP-9 level.Patients with blood-stasis syndrome have the highest MAP difference during and after hemodialysis.In deficiency-sthenia syndrome,the differentiation in pre-hemodialysis systolic pressure,MAP difference after hemodialysis,serum calcium and MMP-9 of different sthenia syndrome groups based on Qi deficiency of spleen and kidney syndrome is of statistical significance.In these syndromes,Qi deficiency of spleen and kidney with damp-turbidity syndrome has a higher pre-hemodialysis systolic pressure and MMP-9 level,and Qi deficiency of spleen and kidney with wind-stirring syndrome has a sharper MAP difference after hemodialysis.The differentiation in weight gain rate,MMP-9 of different sthenia syndrome groups based on deficiency of both Qi and Yin syndrome is of statistical significance,of which deficiency of both Qi and Yin with water-vapor syndrome has the highest level.The differentiation in CRP of different sthenia syndrome groups based on Yin deficiency of liver and kidney syndrome is of statistical significance,of which Yin deficiency of liver and kidney with wind-stirring syndrome has the highest level.11.Correlation study between gender and its clinical indicators:The differentiation in weight,Kt/V,Kt/V standardized rate,serum creatinine,hemoglobin,EPO doses,serum calcium,rennin between the male and female groups is of statistical significance.Male patients have lower Kt/V standardized rate and less EPO doses but a higher level of pre-hemodialysis weight,serum creatinine,hemoglobin,serum calcium and renin.It is speculated that male makes up for a higher proportion in damp-turbidity syndrome patients,and it may be related to their poor capacity in removing small molecular uremic toxins.12.Correlation study between syndromes and hemodialysis:In two groups that different dialysis frequency,the differentiation in prevalence rate of deficiency syndrome and sthenia syndrome is of statistical significance.In deficiency syndrome,a higher proportion of patients with deficiency of both Yin and Yang syndrome,Yang deficiency of spleen and kidney syndrome,Qi deficiency of spleen and kidney syndrome receives hemodialysis twice a week;in sthenia syndrome,a higher proportion of patients with wind stirring syndrome,water-vapor syndrome and damp-turbidity syndrome receives hemodialysis twice a week.In the two groups that different dialysis treatments,the differentiation in prevalence rate of deficiency syndrome and sthenia syndrome suggests no statistical significance.13.Correlation study betweem TCM syndromes and the using of antihypertensive drugs:on syndromes and the type of antihypertensive drugs,of deficiency syndrome,more Yang deficiency of spleen and kidney syndrome patients need not to take antihypertensive drugs(30%);Yin deficiency of liver and kidney syndrome patients use CCB more frequently(70.8%);Qi deficiency of spleen and kidney syndrome patients tend to choose CCB and ACEI/ARB(73 cases,64%for each);Yin deficiency of liver and kidney syndrome patients have the highest proportion in using P blockers(62.5%)and a blockers(31.3%);deficiency of both Yin and Yang syndrome patients seldom use a blockers.In sthenia syndrome,a higher proportion of water-vapor syndrome patients need not to use antihypertensive drugs(38.5%),but only a small proportion of damp-turbidity patients need not to use the drugs,and they choose CCB(76.8%)and ACEI/ARB(71%)more frequently;wind-stirring syndrome patients make up for the highest proportion in using ? blockers(55.6%);damp-turbidity patients have the highest rate in using a blockers(27.5%).On syndromes and combined medication,in deficiency syndrome,patients with Qi deficiency of spleen and kidney syndrome make up for the highest proportion in using single type of antihypertensive drugs(17.5%);most patients with deficiency of both Qi and Yin syndrome receive double medication(32.5%);most patients with Qi deficiency of spleen and kidney syndrome,Yin deficiency of liver and kidney syndrome,and deficiency of both Yin and Yang syndrome receive triple medication(27.2%,33.3%,and 27.8%respectively);most Yin deficiency of liver and kidney syndrome patients receive quadruple medication(18.8%).In sthenia syndrome,patients with damp-turbidity syndrome make up for the highest proportion in using single type of antihypertensive drugs(15.9%);most patients with blood-stasis syndrome and damp-heat syndrome receive double medication(25.8%and 28.7%respectively);most patients with damp-turbidity syndrome and wind-stirring syndrome receive triple medication(31.9%,55.6%respectively);most damp-heat syndrome patients receive quadruple medication(16.1%).To conclude,the differentiation in combined medication of different deficiency syndrome and sthenia syndrome groups suggest no statistical significance.Conclusion1.MMP-9 is one of the risk factors that leads to hemodialysis hypertension,the rising of MMP-9 level may be related to inadequate hemodialysis treatment and microinflammation.Prolonging dialytic duration or increasing dialysis frequency can have certain effects on lowering MMP-9 level.2.On the distribution of syndromes,in deficiency syndrome,most patients have Qi deficiency of spleen and kidney syndrome,followed by deficiency of both Qi and Yin syndrome,Yin deficiency of liver and kidney syndrome,Yang deficiency of spleen and kidney syndrome,and deficiency of both Yin and Yang syndrome.In sthenia syndrome,most patients have blood-stasis syndrome,followed by damp-heat syndrome,damp-turbidity syndrome,water vapor syndrome and wind stirring syndrome.On the whole,the most commonly seen syndrome is Qi deficiency of spleen and kidney with damp-turbidity syndrome,followed by Qi deficiency of spleen and kidney with blood-stasis syndrome.3.In sthenia syndrome,the factor that affects the hypertension syndrome distribution of MHD patients is the damp-turbidity syndrome.The TCM treatment for hypertension in hemodialysis-associated hypertension should be differ from the TCM treatment for primary hypertension.TCM treatment in hemodialysis-associated hypertension should focus more on resolving dampness and decresing turbidity.4.Damp-turbidity syndrome patients with hemodialysis-associated hypertension usually have a poor capacity in removing small molecular uremic toxins.In clinical treatment,we need to pay attention to control the blood pressure of MHD patients with damp-turbidity syndrome.These patients are suggested to prolong their dialytic duration or to increase their hemodialysis frequency.