| BackgroundChronic kidney disease (CKD)is one of the serious diseases that endanger human health and life. End-stage renal disease requires high cost of renal replacement therapy,such as dialysis and renal transplantation. Consistent with the findings of the international developed countries, the prevalence of CKD in China in 2012 has been as high as 10.8%, which has become a huge challenge for public health. Most causes of CKD are irreversible and continue for life, and treatment is aimed to delay the progression of renal failure.However, KDIGO guidelines explicitly pointed out that chronic does not mean that is not reversible, some cases may be spontaneous or complete remission after treatment; some cases can be partially alleviated after treatment. The reason to emphasis on the diagnosis of primary disease is that chronic kidney disease caused by different primary disease has distinct reversibility, prognoses and treatment, In order to achieve the purpose of delaying the decline of renal function or even improving the renal function, effective treatment for the primary disease should be done. Taking into account that the treatment of primary disease may contribute to the improvement of the prognosis of patients with chronic kidney disease,2012 KDIGO guidelines increased the cause to conform the staging criteria of CGA. Modern medical treatment of chronic kidney disease, mainly including the treatment of the original disease, risk factors and complications. Clinical study of traditional Chinese medicine shows that it has an advantage in delaying the progression of renal function, improving clinical symptoms and quality of life of patients with chronic kidney disease. However, it should be recognized that there are still some problems in the clinical study of chronic kidney disease in traditional Chinese Medicine, such as the observation time is short, the case sample is small, insufficient clinical observation of the end point and so on. Therefore, it is very important to find and optimize the prescription of traditional Chinese medicine for the treatment of CKD. Huan Shuai recipe is prescribed by Professor Xiwen Dai, who is the founder of Guanganmen hospital nephrology. The recipe reflects the therapies of supplementing qi and activating blood circulation, removing dampness and reducing turbid. Clinical studies have confirmed the role of improving the quality of life of patients with symptoms and delaying the progression of renal failure. This study to explore the suitable CKD population based on a large number of clinical evidence for the treatment of CKD in the past.ObjectiveIn order to guide the clinical treatment of chronic kidney disease caused by different primary diseases, the study investigates the effect of Huanshuai formula in the renal function of CKD3-4 patients who with different primary diseases,MethodsA retrospective analysis of 90 cases of patients with complete data was made. Patients who met the inclusion/exclusion criteria and treated by Huanshuai formula in Guanganmen Hospital nephrology department were included. The initial treatment period ranged from January 29,1990 to December 9,2015, and the cut-off time was March 10,2016. The median follow-up time was 32.5 months.90 cases divided into glomerular disease group, tubulo interstitial disease group, renal vascular disease group with primary disease, all of them were treated with Huanshuai formula combined with CKD integrated treatment. Observe and record the detection of clinical renal function indexes (SCr, BUN, UA, eGFR, HCO3, 24h-UTP), nutrition state indexes (ALB, HGB) and lipid metabolism parameters (CHO, TG, LDL-C, HDL-C), blood pressure, blood sugar and TCM syndrome. To compare the difference among 3 groups of patients with different primary disease, including the surrogate endpoints, renal function, lipid metabolism, nutritional status and clinical outcome.ResultsHuanshuai recipe has good short-term and long-term curative effect in 90 patients’SCr decline. Both in the third months of treatment and at the end of the observation, SCr levels are lower than the baseline, which are with statistical significance. Huanshuai recipe significantly reduced SCr of groups with different primary disease, but there is no significant difference in ASCr among three groups.Huanshuai recipe has good short-term and long-term curative effect in 90 patients’eGFR improvements. Both in the third months of treatment and at the end of the observation, eGFR levels are higher than the baseline, which are with statistical significance. Huanshuai recipe significantly improved eGFR of groups with different primary disease and different GFR levels, but there is no significant difference in AeGFR among three groups.There is no significant difference in GFR-Slope among groups with different primary disease. GFR-Slope is negatively correlated with treatment time, which means the longer treatment time, the lower the GFR-Slope. GFR-Slope is negatively correlated with the baseline value of CHO, which means the greater the baseline value of CHO, the lower the GFR-Slope. GFR-Slope is related to sex, and the GFR-Slope of the male is higher than that of the female. GFR-Slope is not correlated with the baseline values of BUN, UA, HCO3, P, ALB, TG, LDL-C, HGB.28 patients with glomerular disease, their 24h-UTP value are lower at the end of the observation than the baselineThe lipid metabolism parameters and nutrition indexes of groups with different primary disease are not obviously improved after treatment with Huanshuai recipe.The treatment can efficiently improve the symptoms of TCM for patients in CKD3-4 level. There is no significant difference among groups with different primary disease.Conclusions1. The treatment can efficiently improve the symptoms of TCM for patients in CKD3-4 level, but there is no significant difference among groups with different primary disease.2. Huanshuai recipe combined with CKD integration treatment have good short-term and long-term curative effect in protection of renal function for CKD level 3-4 patients with different primary disease. The treatment can effectively reduce the serum creatinine, stable or even improve glomerular filtration function, improve the quality of life, delay the progression of renal failure; however, there was no statistically significant difference among groups with different primary disease. |
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