The Survival Time Of Hemodialysis Patients With Different TCM Syndromes And Its Associated Factors

ObjectiveThe present study aimed to explore the correlation between TCM syndromes and the survival time of patients on maintenance hemodialysis(MHD)and related factors that influence the prognosis of survival,and to provide basis for clinical practice of Chinese medicine that aims to improve the prognosis of hemodialysis patients.MethodsMedical records of patients who were diagnozed with end-stage renal disease and started maintenance hemodialysis in Hemodialysis Department,Guangdong Provincial Hospital of Chinese Medicine during January 1,2006-December 31,2010 were collected.According to the inclusion and exclusion criteria of the study,eligible cases were included for this retrospective analysis.The interested information includes demographic characteristics,TCM syndromes,hemoglobin levels,serum albumin levels,glomerular filtration rate and comorbidities at the time of dialysis initiation.The patients were followed up till they reached clinical outcomes(death,survival or any other outcome)or the end of the study(December 31,2016),i.e.at least 6 years of follow-up.Survival analysis was used to compare the survival time of MHD patients with different TCM syndromes,and to explore the relevant clinical factors affecting their survival time.Results1.There were a total of 197 MHD patients over a 5-year period,of which 164 were included in the study.The deficiency of spleen-kidney qi was the most common type of dialysis syndrome in hemodialysis patients,127 cases(77.43%).In the case of evil demonstration,107 cases(65.24%)with blood stasis,103 cases(62.80%)with water-qi syndrome,97 cases(59.15%)with wet syndrome,and 38 cases(23.17%)with damp-heat syndrome.2.The average survival time of MHD patients in the center was 7.41 years,and the 1-year,3-year,and 5-year survival rates were 92.90%,76.13%,and 63.87%,respectively.Most of the causes of death were cardiovascular and cerebrovascular events,accounting for 45.24%,followed by infection(9.52%)and gastrointestinal bleeding(7.14%).3.Different empirical MHD patients have different survival times,and the survival time of patients with more than two positive results is shorter than the survival time of patients with two positive results(3 empirical vs.1 empirical: 5.82 yr vs 8.35 yr,P=0.016 Four empirical vs.one empirical: 5.28 yr vs.8.35 yr,P = 0.006).Patients with more than two positives had shorter survival times than those with two positive patients(3 empirical vs.2 empirical: 5.82 yr vs 8.21 ys,P=0.012,4 empirical vs.2 empirical: 5.28 yr vs 8.21,P=0.024).The wetness syndrome and Shuiling Lingxin syndrome in the empirical study were related to the survival time of patients(moisture phlegm: 6.53 yr vs 8.58 yr,P=0.001;Shui Yin Lingxin: 6.33 yr vs 8.94 yr,P=0.001).4.Patients with over 50 years of age who entered dialysis had a shorter mean survival time than those less than 50 years(6.77 yr vs 9.36 yr,P < 0.001).Patients with MHD who had hypertension,diabetes,or heart failure had a shorter survival time compared to those without comorbidities(Hypertension: 6.75 yr vs 8.06 yr,P=0.016;Diabetes: 6.58 yr vs 7.69 yr,P=0.04 Heart failure: 6.33 yr vs 8.10 yr,P=0.001).Conclusions1.Different empirical MHD patients have different survival times.The presence of wet turbid syndrome or Shuiling Lingxin syndrome when entering dialysis is associated with a poor prognosis,and the more patients with positive evidence,the worse the survival prognosis.2.The age of entering dialysis over 50 years,combined with hypertension,diabetes,and heart failure are the factors affecting the short survival time of MHD patients.3.The age of entering dialysis over 50 years old,complications of heart failure when entering dialysis,and Shuiling Lingxin syndrome in TCM syndromes are independent risk factors for premature death of MHD patients.