| Objective:To evaluate the efficacy and safety of traditional Chinese medicine(TCM)on middle stage and late stage chronic kidney disease(CKD)progression through systematic reviewing the literatures of TCM on chronic renal insufficiency(CRF)randomized controlled trials.To explore the influence on the dialysis outcomes of TCM for CRF patients,via screening the factors related with dialysis outcome,through clinical retrospective observation.Methods:(1)Literatures of randomized controlled trials on treating CRF by TCM were researched from literature databases including CNKI,VIP,CBM,Wanfang data,PubMed,EMBASE and Cochrane Library;the therapeutic efficacy and safety of TCM were analyzed by Review Manager 5.3.(2)The patients admitted to the main diagnosis of CKD4-5,but not being treated with dialysis were recruited in Chinese and Japanese Friendship Hospital,from January 1,2012 to December 31,2015;the basic characteristics,clinical test indicators,medication information and prognosis were collected to analyze the occurrence of dialysis outcome and the factors affecting the outcome of dialysis via COX regression.Results:(1)For systematic literature review,721 literatures were retrieved,including 11 meta-analysis.The symptoms,signs and glomerular filtration rate of CRF patients with TCM were improved and TCM played a certain role in the reduction of serum creatinine,blood urea nitrogen,24-hour urine protein;considering fewer researches on safety indicator and adverse reaction were reported,the safety of TCM treatment could not be evaluated effectively.There were still lack of research on the outcome of disease progression,and still needfurther clinical research to evaluate the long-term efficacy of TCM in the treatment of chronic kidney disease.(2)In this clinical study,120 cases of CKD4-5 patients were included and were divided into exposure group(47 cases)treated with TCM and non-exposed group(73 cases)treated with western medicine.All the cases were followed up for 1 year.52 patients ended with dialysis treatment,including 12 cases(25.53%)from the exposed group and 37cases(50.68%)from non-exposed group,with a significant difference(P = 0.006<0.05)on the occurrence rate of dialysis between above 2 groups;compared with western medicine treatment,TCM treatment reduced the incidence of dialysis.Moreover,relative ratio(RR)= 0.50<1,TCM was protective factor preventing CRF progression into the dialysis.Compared with non-dialysis group,age and the incidences of high phosphorus,low calcium along with hyperglycemia respectively,were higher in dialysis group;CO2,hemoglobin and the use rate of TCM were lower in dialysis group(p<0.05);after the above variables were gradually introduced into the COX multivariate regression model,the results showed that the use of Chinese medicine and hemoglobin were protective factors for delaying dialysis outcome,and hyperglycemia and high phosphorus and low calcium were independent risk factors accelerating the progression to dialysis outcome.Conclusion:TCM could improve the efficacy of CRF,delay the dialysis outcome,however,there still exists needsfor more large-size sample,multi-center,prospective randomized controlled trial to further confirm that Chinese medicine could delay the progress of chronic kidney disease.Chinese medicine and hemoglobin are protective factorsfor dialysis outcome;high phosphorus,low calcium and hyperglycemia are risk factors for dialysis outcome,so for patients with chronic kidney disease,to use TCM to intervene the progression to renal failure,meanwhile to monitor the flux of hemoglobin,calcium and blood glucose,could prevent CKD progression effectively. |
PDF Full Text Request