| Objective:To explore the the correlation between the timing of dialysis and the prognosis of dialysis patients by analyzing retrospectively the data of the first hemodialysis patients registered in the hemodialysis registration system of our hospital.At the same time,to preliminary conduct the study of the traditional Chinese medicine treatment of"xiaozhengsanjie" to delay the timing of dialysis of CKD5 phase patients based on the theory of "shenluozhengjia".Methods:(1)Study 1:To analyze retrospectivly the data of the first hemodialysis patients registered in our hospital from January 1,2011 to December 31,2016,including the general information,laboratory tests,primary cause of disease,changes of dialysis timing,hemodialysis vascular access,and compared with the annual data report from United States Renal Data System in the same period.And then,all the patients were divided into two groups in accordance with the eGFR at the beginning of dialysis from 201 1 to 2015:eGFR>5ml/min/1.73m 2 group(n=293 cases)and eGFR<5ml/min/1.73m 2 group(n=226 cases),and follow-up to December 31,2016.The correlation between dialysis timing and prognosis was analyzed with Kaplan-Meier survival curve before and after propensity score match(PSM)by SAS software.(2)study 2:all the CKD5 phase with non-dialysis patients in our hospital and Qian'an City kidney disease hospital of Hebei Province from January 1,2014 to December 31,2015 were divided into two groups:the western medicine group(shortened form:western medicine group n=67 cases),the traditional Chinese medicine group(shortened form:TCM treatment group,n=69 cases).The study was designed for entering the group continuously and non-randomized controll.The follow-up time was until December 31,2016.The main observation indicators was the time of delaying the first time for dialysis and the percent of end points which was desigeneu as if the patient go into the dialysis or eGFR?5ml/min/1.73m2.At the end of follow-up,Kaplan-Meier survival curves were used to analyze the time from the date which every patient entering the group to first dialysis and cumulative survival rate in the two groups.At the same time,the statistics of all patients in the TCM treatment group were analyzed including the frequency to the doctor,the symptoms and herbal prescription,which were used to summary the tutor's experience and characteristics for the treatment of chronic renal failure.Result:(1)study 1:A total of 616 patients were enrolled from January 1,2011 to December 31,2016,with 367 males and 249 females and male to female ratio of about 1.47:1.The average age of 616 patients was 58.0±13.4 Year old,the median age is 59 years old.The average age of males was 57.0±13.4 years old.The average age of females was 59.9±13.2 years old.Among them,51%were younger than 60 years old and 49%patients were over 60 years old.About 17%patients were older than 75 years old in all dialysis patients.The first major cause of dialysis is chronic nephritis,the proportion of 36%(221 cases),followed by diabetic nephropathy,accounting for 33%(204 cases),the proportion of hypertensive nephropathy was 9%,interstitial nephritis 5%,Polycystic kidney disease 4%,other causes 13%,and in 2016,the proportion of diabetic nephropathy more than chronic nephritis for the first time(38.1%vs 32.0%).there was no significant difference between Serum creatinine,blood urea nitrogen,total protein,blood phosphorus levels in two groups,but albumin(P=0.027),serum calcium(p=0.009),hemoglobin(p<0.05)were not exactly the same,the difference was statistically significant.The average eGFR of all patients was 6.31±3.85 ml/min/1.73m2,and the level of eGFR(7.92±4.95 ml/min/1.73m2)in patients with diabetic nephropathy was significantly higher than that in patients with non-diabetic nephropathy(5.51±2.84ml/min/1.73m2),the difference was statistically significant(p<0.01).43%of all patients had dialysis initiation eGFR?5ml/min/1.73 m2,the percent of patients dialysis starting 5ml/min/1.73m2<eGFR?10ml/min/1.73m2 accounted for 45.8%,only 11.2%of patients with dialysis initiation eGFR>10ml/min/1.73m2.From 2011 to 2016,about 90%of patients in each year started dialysis at eGFR?10ml/min/1.73m2.50%of patients used autologous arteriovenous fistula as the initial vascular access with the first time to dialysis,41%of patients were temporary catheterization,long-term catheterization of patients accounted for 5%,only 1%of patients Using an intravascular fistula.All the patients who started dialysis from January 1,2011 to December 31,2015 were divided into two groups according to dialysis initiation(eGFR>5ml/min/1.73m2 and eGFR?5ml/min/1.73m2)and then followed up to December 31,2016.The two groups were included in 519 patients before propensity score match,including eGFR>5ml/min/1.73m2 group of 293 cases,in which 204 cases were still dialysis,6 cases kidney transplantation,41 cases died,42 cases were lost follow-up at the end of follow-up,eGFR<5ml/min/1.73m2 group of 226 cases,in which 167 cases were still dialysis,6 cases of renal transplantation,27 cases died,26 cases lost.There was no significant difference in age,body mass index,hemoglobin and serum calcium between the two groups(p>0.05).The difference between the two groups was statistically significant(p<0.01)in other parameters.Kaplan-Meier survival curves were used to analyze the cumulative survival rate in two groups,which showed that there was no significant difference in log-rank test(p=0.299).After the data of two groups were matched by propensity score match(PSM)with SAS software,the two groups were included in 276 patients and 138 patients in each group.There was significant difference between serum creatinine,blood urea nitrogen,eGFR of dialysis initiation(P<0.01)in two groups on the baseline.There was no significant difference in other parameters between two groups(p>0.05).After the match,the survival rate of two groups was calculated by K-M survival curve.The survival rate of the two groups was statistically significant was no significant difference in log-rank test(p=0.547).(2)Study 2:In this study,274 cases of CKD5 non-dialysis patients were screened out,138 cases were excluded,in which 8 cases were<18 years old,13 cases>75 years old,46 cases had secondary renal failure,37 cases had eGFR<10ml/min/1.73m2,34 cases of blood pressure>150/90mmHg.Finally,total of 136 cases of were included,of which 69 cases of Chinese medicine treatment group,including 37 males,32 females,Western medicine group 67 cases,including 42 males and 25 females(P=0.302).There was no significant difference on gender between the two groups(p=0.302).There was no significant difference in age,diastolic blood pressure,hemoglobin,albumin,body mass index,systolic blood pressure,serum creatinine,eGFR,total Protein(p>0.05).At the end of the study,24 patients in the Chinese medicine treatment group had end events,the incidence of end points was 34.8%,56 patients in the western medicine group had end events,the incidence of end points was 83.6%.The difference between the two groups was statistically significant(P<0.01).The cumulative survival rate of two groups of patients were analysied by Kaplan-Meier survival curve,of which the median survival time of patients in traditional Chinese medicine treatment group was 25 months(95%CI:18.2-3 1.8),Western medicine treatment group median survival time was 9 months(95%CI:7.6-10.4).The log-rank test showed that the cumulative survival rate of the two groups was statistically significant(p<0.01).The first time to dialysis was analyzed in all the dialysis patients of the two groups.24 patients in the Chinese medicine treatment group had end events,the average duration of the first dialysis was 12.6 months(95%CI:10.5-14.7)and 56 patients in the western medicine group had end events,the average duration of the first dialysis was 8.5 months(95%CI:7.4-9.6),Kaplan-Meier survival curve analysis showed that the time from diagnosis of CKD5 to the first time to dialysis had a significant difference between the two groups(p=0.001).The reason of two groups of patients went into the dialysis were analysed:a total of 24 patients in the treatment group into the dialysis,of which 6 cases because of heart failure,gastrointestinal symptoms,edema and other reasons,18 patients eGFR?5ml/min/1.73m2 during the follow-up;in Western medicine treatment group,56 patients went into dialysis,of which 19 patients due to heart failure,gastrointestinal symptoms,37 patients patients eGFR?5ml/min/1.73m2during the follow-up.The experiences of treatment for chronic renal failure from Professor Wang Yaoxian were also summarized.It is found that the "shenluoZhengjia" theory was the basis,"XiaozhengSanjie" was the basic prescription.Professor Wang Yaoxian emphasised on the prevention and treatment chronic renal failure patients with heart disease according to "heart and kidney theory".Also professor Wang Yaoxian elected four gentlemen decoction and five sub-Yanzong pills for the deficiency of spleen and kidney,while blood circulation,removing damp and turbid and detoxification for sthenia pathogenic factors.Conclusion:1.During past 6 years,the dialysis patients in our hospital was mainly middle-aged and elderly,male was more than female,and the proportion of patients who were more than 60 years old was higher.The cause of newly diagnosed patients into dialysis was chronic nephritis,diabetic nephropathy,followed by hypertensive nephropathy.Diabetic nephropathy has been more than chronic nephritis to become the leading cause of hemodialysis in 2016.The control rate of hemoglobin,blood phosphorus and blood calcium in the new dialysis patients was lower,and also the initial of dialysis was very late.The initial eGFR of patients with diabetic nephropathy was slightly higher than that of patients with non-diabetic nephropathy.The first hemodialysis vascular accesses were mainly arteriovenous internal fistula,but the proportion of central venous catheter is still high.There was no difference between the early and late dialysis for the prognosis of patients.2."ShenluoZhengjia" theory is a common pathogenesis of chronic kidney disease,the prescription "XiaozhengSanjie" can delay the CKD5 non-dialysis patients for the first time into the dialysis time,reduce the CKD5 patients dialysis Incident rate.3.Qi deficiency and blood deficiency are the most deficiency common syndrome in CKD5 non-dialysis patients,and blood stasis,drowning card,damp-heat syndrome are the most common standard empirical.4.The experiences of treatment for chronic renal failure from Professor Wang Yaoxian were also summarized.The "shenluoZhengjia" theory was the basis,"XiaozhengSanjie" was the basic prescription.Professor Wang Yaoxian emphasised on the prevention and treatment chronic renal failure patients with heart disease according to "heart and kidney theory".Also professor Wang Yaoxian elected four gentlemen decoction and five sub-Yanzong pills for the deficiency of spleen and kidney,while blood circulation,removing damp and turbid and detoxification for sthenia pathogenic factors. |
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