Study On The Correlation Between Depression,anxiety And TCM Syndrome And Prognosis In Patients With Chronic Kidney Disease

Purpose:To investigate the correlation between depression and anxiety in patients with chronic kidney disease and TCM syndrome and prognosis.Method:The basic situation,laboratory index and TCM syndromes were recorded in 165 cases of CKD patients who were followed up from February 2002 to February 2016 in the Department of Nephrology,Hubei Provincial Hospital of Traditional Chinese Medicine.Self-Rating Self-Rating Depression Scale(SDS)was used to evaluate the symptoms of depression.Self-Rating Anxiety Scale(SAS)was used to evaluate the symptoms of anxiety and follow-up.The incidence of end points such as dialysis and death in CKD patients was recorded.The end event is listed as censored data.The risk ratio(HRs)of CKD patients was evaluated by COX proportional hazards model in the two groups,the relative situation of depression and anxiety,laboratory indicators,TCM syndromes and survival rates.Results:1.Of the 165 patients with CKD1~5,157 patients were followed up and8 were lost.Among them,90 males and 67 females were aged from 29to 73 years.The mean age was 57.30±12.10 years,with an average follow-up of 30.41±18.30 months;CKD1 patients in 8 cases,CKD2 in 31 cases,63 cases of CKD3,42 cases of CKD4,CKD5 in 13 cases,41 cases of CKD patients reached the end(35 patients with dialysis endpoint,6patients died).2.There were no significant differences in gender,educational level,smoking,drinking,body mass index(BMI),and hypertension,diabetes mellitus,and urologic surgery.(P>0.05).There was significant difference in age,family income,cerebrovascular disease and other aspects(P<0.05).Periods in patients with chronic kidney disease(CKD)in the laboratory indexes and depression,anxiety is concluded: CKD1~5 in patients with hemoglobin(HGB),and total bilirubin(TBIL),direct bilirubin(DBIL)with renal function decline gradually declining,the difference was statistically significant(P<0.05);CKD1~5 patients with alkaline phosphatase(ALP),creatinine(Scr),uric acid(UA),and kalium(K),Cystatin_C(Cystatin_C),parathyroid hormone(PTH),24 h urine protein with kidney function decline gradually rise,and the difference was statistically significant(P<0.05),CKD1~5 patients low density lipoprotein(LDL-C)between groups,blood phosphorus(P),blood calcium(Ca)difference was statistically significant(P<0.05).3.Among the patients with CKD1~5,there were 85 cases(54.1%)with depression.With the decrease of renal function,the depression gradually increased.Among them,38 cases(24.2%)had anxiety status.With the decrease of renal function,Also show an upward trend.4.157 patients CKD1~5 for this deficiency syndrome of spleen and kidney deficiency syndrome,liver and kidney Yin deficiency syndrome,spleen and kidney Yang deficiency syndrome,qi and Yindeficiency syndrome,respectively in 61 patients(38.9%),24 cases(15.3%),52 cases(33.1%),20 cases(12.7%),with spleen and kidney deficiency syndrome,spleen and kidney Yang deficiency syndrome is the most common;In the empirical is given priority to with dampness syndrome,a total of 72 cases(30.6%),followed by wet and heat syndrome 45 cases(39.5%),blood stasis syndrome of 40 cases(29.9%).This deficiency syndrome:CKD1~3 phase of patients with spleen and kidney deficiency syndrome,the most common CKD4~5 in patients with spleen and kidney Yang deficiency syndrome is the most common;The empirical: CKD1~2 is given priority to with damp heat syndrome,CKD3~5 period is given priority to with dampness syndrome.5.Compared with the negative patients with depressive symptoms,was the family income(P<0.001),education levels are relatively low(P =0.010),there will be a history of hypertension(P=0.003),and laboratory examination of HGB(P=0.015),LDL-C(P=0.035),UA(P=0.025)level is low;Compared to patients with anxiety symptoms,negative,positive family income(P<0.001),degree of education are also relatively low(P=0.010),and always will be a history of cerebrovascular disease(P=0.002),and laboratory examination of glutamyltranspeptidase(?-GT)(P=0.004)levels are low.6.The depression group of spleen and kidney deficiency syndrome,liver and kidney Yin deficiency syndrome,spleen kidney Yang deficiency syndrome,qi and Yin deficiency syndrome with 34 cases(40%),9 cases(10.6%),31 cases(36.5%),11 cases(12.9%),depression group this deficiency in spleen and kidney deficiency syndrome in patients with the most common;The empirical in the wet muddy syndrome,wet and heat syndrome,blood stasis,respectively,there are 26 cases(30.6%),28cases(32.9%),31 cases(36.5%),the depression group patients thewinning empirical with blood stasis syndrome is the most common.7.Spleen and kidney deficiency syndrome in anxiety group,liver and kidney Yin deficiency syndrome,spleen and kidney Yang deficiency syndrome,qi and Yin deficiency syndrome there were 6 cases(15.8%),16 cases(42.1%),2 cases(5.3%),14 cases(36.8%),anxiety patients in this deficiency syndrome in liver and kidney Yin deficiency syndrome and qi and Yin deficiency syndrome is the most common.The empirical in the wet muddy syndrome,wet and heat syndrome,blood stasis,there were 19 cases(50%),11 cases(28.9%),8 cases(21.0%),the empirical evidence in the wet muddy syndrome is the most common.8.4 years of follow-up survival curves showed that merge depression or anxiety of patients to show a higher incidence of end events.By COX survival analysis showed that merge depression symptoms in patients with chronic kidney disease(CKD)end point events of HRs of 1.05(95% CI:0.52 2.14),the merger of anxiety symptoms in patients with chronic kidney disease(CKD)end point events of HRs of 1.10(95%CI:0.48 2.52).9.64 patients without depression or anxiety,30 cases of patients with both anxiety and depression,only 55 patients depression,only 8patients anxiety,results in both depression and anxiety of patients with HRs of 1.09(95% CI:0.39 3.05),only the anxiety of patients with HRs is1.20(0.55 2.61),only the depression patients with HRs of 1.75(0.466.62).On depressive symptoms and anxiety symptoms and no show accumulative effect;Merge depression or anxiety of patients did not show the trend of decline in renal function.Conclusion:1.CKD1~5 patients with depression and anxiety symptoms are more common.With the decline in renal function,depression,anxiety symptoms gradually increased.Depression symptoms in the TCM syndrome in the formation of silicosis may have a certain role;anxiety symptoms in the deficiency of traditional Chinese medicine in the liver and kidney yin deficiency syndrome and the formation of qi and yin deficiency may play a role.2.CKD1~5 patients with deficiency syndrome in the spleen and kidney qi deficiency syndrome,spleen and kidney yang deficiency is the most common,standard evidence to wet turbid syndrome common.With the decline in renal function,the deficiency in the proportion of spleen and kidney yang deficiency patients gradually increased,the proportion of evidence in the blood stasis gradually increased,wet turbid syndrome and blood stasis is CKD4~5 patients the most important evil evidence.3.Depression symptoms will increase the risk of entering the end of the event;anxiety symptoms also show the same trend.Anxiety depressive symptoms are not cumulative effect.Patients with depression or anxiety did not result in kidney function decreased.4.The results of this study suggest that early attention should be paid to depression and anxiety in CKD patients and improve the symptoms of depression and anxiety in patients with CKD.Early intervention and control of HGB,electrolyte,UA,Scr,PTH and other indicators in CKD patients,Of the blood syndrome,liver and kidney yin deficiency and Qi and Yin deficiency etc to delay the progress of the disease,improve the prognosis of the kidney is important.