Clinical Retrospective Study On Treatment Of Chronic Renal Failure With

Objective:Analysis the outcome events in patients with chronic renal failure and excavate the risk factors affecting the prognosis of the patients with chronic renal failure.To observe the advantage and effect of the Guben Xiezhuo dialectical therapy in delaying progression of renal function and reducing the occurrence of outcome events,then provide evidence-based basis for TCM treatment of chronic renal failure.Methods:Use the retrospective cohort study method, select all of the out-patient and in-patient patients in WangJing hospital from January 1st 2010 to June 30th 2014 who accorded the inclusion criteria. Take the first time of patients with treatment as the baseline and chose June 30th 2015 as the deadline. Record all of the intervention factors,prognostic factors and prognostic indicators,fill in the CRF tables and entered into an Excel spreadsheet.Observe the incidence of chronic renal failure patients with total endpoint and the primary endpoint.Regard the solid the Xiezhuo method as exposure factors, according to solid the Xiezhuo method treatment stratification and analysis the effect of Guben Xiezhuo dialectical therapy in delaying progression of renal function and reducing the occurrence of outcome events.At the same time,research the risk factors affecting the prognosis of chronic renal failure.Results:1.General situation:The median age of the 167 cases was 68 (58.5,74) years old.There wre 122 cases who is older than 60 years,accounting for 73.05% of the total cases. There were 89 cases of male patients, accounting for 53.29% of the total cases and the proportion of men and women is 1.14:1.The top three of the primary disease were diabeticnephropathy(46.71%) chronic glomerulonephritis(21.56%) and hypertensive nephropathy(11.98%).In the 167 patients,there were 37 cases with elevated serum creatinine as early symptoms,accounting for 22.16% of the total cases.2.Outcome event:There were 73 cases occurred outcome event in 167 patients.The main outcome events had 42 cases,including 4 cases of death(2 patients died of renal failure complicated with digestive tract hemorrhage,2 patients died of renal failure complicated with heart failure) and renal replacement therapy(hemodialysis or peritoneal dialysis) in 38 cases.The secondary endpoints had 31 cases,including 15 cases who had been into ckd5 without dialysis,11 cases whose serum creatinine double and 19 cases of serious cardiovascular and cerebrovascular events.The 19 cases included 6 cases of acute left heart failure,5 cases of acute myocardial infarction (AMI),6 cases of acute cerebral infarction,2 cases of cerebral hemorrhage.There were 14 patients with the other endpoints in the 19 cases.None of the patients was severe sepsis.3.Analysis result about the Cox regression of total outcome events(main outcome events and secondary outcome events):The risk factors that affect the CRF patients occurred total outcome events were CKD stage,electrolyte disorders and massive proteinuria.CKD stage rose per level,then the risk of the total end point opening increased by 2.814 times.The risk about the total end point event of the patients with electrolyte disorder was 1.722 times that patients without electrolyte disorder.The risk about the total end point event of the patients with massive proteinuria was 3.834 times higher than patients without massive proteinuria.4.Analysis result about the Cox regression of primary outcome events(death and renal replacement therapy):The risk factors that affected the CRF patients occur primary outcome events were CKD stage and massive proteinuria.The treatment of Guben Xiezhuo was a protective factor for the progression of CRF patients.The risk about the primary end point event of the patients with massive proteinuria was 6.791 times higher than patients without massive proteinuria.CKD stage rise per level,then the risk of the primary end point opening increases by 4.451 times.The course of traditional Chinese medicine treatment rise per level,then the risk of the primary end point opening increased by 4.451 times decreases by 0.641 times.Classify the course of Guben Xiezhuo and draw a survival curve.The result showed that the survival curve of high exposure group was the highest and decreased slowly.The survival curve of middle exposed group was higher than the other two groups, but lower than the high exposure group.The low exposure group survival curves was only higher than non exposed group and decreased compared to the steep. The non exposed group was lowest and decline steepest.Conclusion:1.Chronic renal failure has the characteristics of aging and onset occult.The primary disease mainly consists of diabetic nephropathy, chronic glomerulonephritis, hypertension kidney disease.2.With the rise of CKD staging, the probability of occurrence of complex end events increased,CKD5 is worse than that of CKD3 and 4, and massive proteinuria and electrolyte disorder are the main risk factors for the occurrence of complex end events in CRF patients. In clinic, we should actively intervene in the early stage.In order to delay the progression of renal function by controlling the patient’s proteinuria and regulating the water electrolyte balance.3.With the rise of CKD staging, the probability of occurrence of primary end events increased,CKD5 is worse than that of CKD3 and 4, and massive proteinuria is an important risk factor that affects the primary endpoint of CRF. The treatment of Guben Xiezhuo for chronic renal failure has an impact on the prognosis and the treatment of traditional Chinese medicine to reduce the incidence of death and renal replacement therapy.