Chronic Renal Failure Follow-up Study Of Clinical Paths

ObjectiveTo evaluate the long-term effectiveness of Clinical pathway for chronic renal failure and provide evidence for further modification of this clinical pathway.MethodWe enrolled patients who had received in-hospital treatment of Clinical pathway for chronic renal failure in Guangdong hospital of TCM during August 2009 and December 2009. The treatment included:(1)symptom-based therapies: blood pressure contrl, serum glucose control, keep balance of fluid, electrolyte and acid-base, correct lipid metabolism, improve anemia, to have high quality low protein, low phosphorus, high calcium diet, prevention of getting cold, forbid to have nephrontoxic drugs; (2) Integrated TCM therapies: san-qi oral liquid, niaoduqing medicinal granule, preparation of Cordyceps sinensis, decoction based on TCM differentiation and Chinese sausage. All these patients keep having the treatment above during their follow-up of 6 months(once per 2 weeks to 1 month). We observed patients changes including symptoms, signs, renal function, blood regular test, serum albumin level etc, during follow-up. SPSS13.0 statistic software package was used to set up database and analysis the change between the time when discharge and at the end of 6-months follow-up.ResultsAugust 2009 and December 2009,55 patients was identified to received in-hospital treatment of Clinical pathway for chronic renal failure in Guangdong hospital of TCM.38 patients fulfilled the inclusion criteria. Sex:22 male and 26 femal;Age:22-79 year old and average age is 52 year old; primary disease:chronic nephritis:19, hypertensive nephropathy:8, nephrotic syndrome:3, diabetic nephropathy:2, lupus nephritis:1, Ischemic nephropathy:1, Polycystic kidney:1, unknown primary disease:2. Efficacy evaluation at the end of 6 months follow-up:Markedly effective in 4 cases (10.5%), effective in 8 cases (21.1%), stable in 14 cases (39.5%),11 cases (28.9%), effective cases and 27 cases, total effective rate was 71.1%. Biochemical indicators:serum creatinine level and blood urea nitrogen level were lowered significantly (P＜0.05) at the end of 6 months follow-up compared to those when discharged, while hemoglobin level and estimated glomerular filtration rate elevated significantly(P＜0.05) and albumin level is slightly elevated but not significantly. For quality of life aspect, all dimensions of SF-36 scores of patients in this study were lower than norm data of Hangzhou when discharged. But after treatment for 6 months, SF-36 scores higher in 8 dimension than before, resulting in significant differences (P＜0.05).ConclusionIn this study, we applied a standardized program for treatment of chronic renal failure including:TCM syndrome differentiation, Chinese medicine, Chinese patent medicines orally, and TCM sausage.Results shows that the program can reduce serum creatinine, urea nitrogen, increased glomerular filtration rate, anemia, renal function progress to end-stage renal disease, with significant long-term effect. After 6 months of treatment, patients improve the quality of life significantly according to SF-36 scores on eight dimensions, and agree with clinical indicators. These provided further evidence that assessment of quality of life should be used as an indicator of efficacy evaluation of chronic renal failure patients.