Climate-related Research, Based On The Nkf-k/doqi Chronic Kidney Disease Stage Of Tcm

Research backgroundChronic kidney disease is a new concept of disease,that is,renal injury or glomerular filtration rate less than 60ml/min/1.73m2 lasted 3 months caused by a variety of primary or secondary kidney disease,divided into five stages according to the disease process.It was proposed in K /DOQI "Chronic Kidney Disease Clinical Practice Guidelines"in 2002 by American Kidney Foundation.Due to higher incidence rate of CKD and special superiority in Traditional Chinese Medicine(TMC) treatment,TCM practitioners have elaborated every aspect of many kind of kidney diseases.Since CKD is a new concept of disease,there has not much previous literature on TCM Syndrome study involving CKD stage from the literature search.The common staging system of Chronic renal failure in Chinese is different from that of CKD.Previous TCM researches on staged Chronic renal failure has fallen far behind the requirements of CKD stages and called for immediate TCM researches on CKD stages based on NKF-K/DOQI.To study CKD syndrome further and investigate the syndrome of different CKD stages and the characteristics and regularity of the primary symptoms,we applied clinical epidemiology research methods such as literature search,expert questionnaire and retrospective study,aiming at studying the relationship between CKD stages and TCM syndrome based on NKF-K/DOQI.ObjectiveAccording to the clinical epidemiology and the principles of evidence-based medicine,the present study is to argued the mechanism of TCM Syndrome on staged CKD by investigate its common symptoms from the K/DOQI "Chronic Kidney Disease Clinical Practice Guidelines" drawn up by American Kidney Foundation in 2002.To provide the Etiology, Pathogenesis and Diagnostics evidence of TMC for the participation of Chinese medicine treatment of CKD and its complications and new ideas, new research methods for the syndrome study of every CKD stage.MethodThe present study applied multi-disciplinary research methods involving epidemiology,statistics,health economics,sociology and so on.The main research methods are as follows:(1) Literature studies:Summarizing the symptoms mentioned in the previous literature and summarizing,analyzing the regularity of TCM through studying retrieved literature of recent 5 years according to EBM evaluation methods.(2) Making expert questionnaire for the symptoms of CKD stages applied the Delphi method(Delphi).(3) Retrospective study:The present study is a retrospective cohort study. It drew up a Observation Table of patients with CKD through investigating medical records of recent 5 years and considering expert questionnaire. This study included 250 patients identified by CKD stages.It retrospectively reviewed the patients' medical records in terms of name, gender,age,past medical history,underlying diseases,symptoms at the time of TCM treatment,laboratory indicators.It primary argued the relationship between the general faintness,weakness of waist and knee, the changes of facial expression and CKD stages through investigating characteristics and changes of the syndrome distribution in every CKD stage.ResultAmong the inclusive 250 patients,there are equal cases in each gender and higher risk of CKD3,4,5 stage lies between 60and 69 years. Three primary causes of chronic glomerulonephritis,hypertensive nephropathy,diabetic nephropathy account for 80-90%of inclusive CKD patients.Qi-deficiency type of all Deficiency Syndromes reached the peak during CKD 3-stage and gradually decreased when it developed into CKD 5 stage(48.33%-7.8%).Yang-type is rare in the early stage,but it gradually increased with the disease progress and reached the highest frequency at CKD stage 5(13.33%-78.9%),suggesting the progressive evolution.Qi and Yin deficiency type also gradually decreased with the disease progress but the total fluctuation is litter.There were no significant differences in each stage in terms of Yin deficiency type and yang deficiency type.The frequency changes of all Deficiency Syndromes in CKD stage 3,4,5 was statistically insignificant(P＜0.05).In Empirical Syndromes,the wet muddy type did not have a high frequency in stage 3,but it gradually increased with the disease progress and reached the peak when it developed into CKD stage 5(20%-68.9%).The frequency of shui-qi type during stage3 is highest,but decreased in the later period Of disease(41.67%-6.7%).The frequency of shi-re type and xueyu-type did not fluctuated significantly in each stage,the two types presented in each stage.The frequency changes of all Empirical Syndromes in CKD stage 3,4,5 was statistically insignificant(P＜0.05).In view of TCM symptoms,there is linear relation between faintness,weakness of waist and knee changing during CKD stage3,4,5,that is,the symptoms of faintness,weakness would become more and more serious with the disease progress.In view of facial expression changing, there is no linear relation between facial expression changing from swarthy looking(stage3) to chlorosis looking(stage4) to not shiny looking (stage5) during CKD stage3,4,5,that is,there was no correlation between facial expression changing and disease progress.In the etiology and pathogenesis,Deficiency nature accompanied by external Empirical was considered the basic pathogenesis of CKD. Deficiency nature accompanied by external Empirical with rare pure Deficiency Syndromes or pure Empirical Syndromes,because Deficiency and Empirical Syndromes involving lower resistance and harmful substances, existence appeared through the disease.At the early stages of disease, kidney injuries by harmful substances or innate defect of renal function influenced the lungs and spleen.The three was closely related to the delivery and metabolism of water.Kidney was important to the delivery and metabolism of water,so there would be water retention if renal function had been deficient.As the disease went worse,damaged yang-qi failed in transpirating and gasifing to regulate water metabolism and govern.Furthermore,the deficient function of kidney and spleen lead to failure in transforming nutrients into qi,blood and body fluid,so warter stayed inside and induced accumulation of heat and wet which injuried body fluid and qi and harm the resistance to harmful substances.After long period with disease,The drug will retain inside with lingering wet.If they are treated incorrectly or loss treatment,there will be kinds of complications.ConclusionThere is a higher frequency of CKD stage3,4,5 at the ages of 60 to 69 years old.The frequency changes of all Deficiency and Empirical Syndromes in CKD stage 3,4,5 was statistically insignificant(P＜0.05). There was a correlation between the frequency of faintness,weakness of waist and knee during CKD stage 3,4,5 and disease progress.However, there was no correlation between facial expression changing and CKD stage and disease progress.