Prospective Study On The Intervention Of TCM Comprehensive Nursing Program Combined With Western Medicine Basic Therapy For Risk Factors Of CKD Progression

Objective:To explore the intervention effect of TCM comprehensive nursing program combined with Western medicine basic treatment on risk factors of chronic kidney disease progression.Methods:The enrolled patients were from the outpatient department of the Department of Nephrology of Hubei Provincial Hospital of Traditional Chinese Medicine,all of which met the criteria for case selection,a total of 72 cases,of which 5 cases were lost in the middle,2 cases were entered into the end point,and 65 cases were Prospective study.All the patients enrolled in the group were evaluated for traditional risk factors before the group was enrolled,and based on the evaluation results of traditional risk factors,the appropriate TCM comprehensive nursery program was selected on the basis of Western medicine treatment.The specific nursery program was from the Guangdong Provincial Hospital of Traditional Chinese Medicine.“A prospective enrollment study on the intervention of risk factors in the progression of chronic kidney disease with TCM comprehensive nursery program”.After each follow-up,patients were asked to fill out a diet questionnaire and a comprehensive Chinese nursery journal to assess patient compliance.Blood pressure measurement,renal function index(BUN,Scr),blood uric acid(SUA),and blood lipid index(TG,TC,LDL-C,HDL-C)were performed before enrollment and after enrollment,urinary albumin/creatinine ratio(ACR),glomerular filtration rate(eGFR)indicators were monitored,and changes in safety indicators such as white blood cells,transaminase,stool routine,and electrocardiogram were regularly monitored,and monitoring data was entered.The chronic disease management system of Guangdong Provincial Hospital of Traditional Chinese Medicine,after the completion of the one-year study,data collection and collation,the data was exported to the EXCEL form,and statistical analysis was performed using SPSS statistical software 23.0,according to the patient before the group was enrolled.The patients were divided into groups according to the stage of chronic kidney disease.According to the laboratory test data before and after the patient was enrolled,statistical analysis was performed to observe the progress of renal function and the control of risk factors.Results:(1)Basic situation:A total of 65 patients were included in the retrospective analysis.There were 44 male patients and 21female patients;the oldest was 79 years old,the youngest was 32years old,and the average age was 59.88±10.73 years old;the longest course of chronic kidney disease was 456 months,and the shortest was April,with an average of 107.83±93.33 months.The largest BMI is 33.3,the minimum is 19.0,and the average is 24.35±3.32.(2)TCM syndrome type distribution:Among the 65 patients,the number of syndromes of spleen and kidney yang deficiency was the highest,accounting for 50.8%,followed by spleen-kidney qi deficiency syndrome,accounting for 33.8%;54 patients among 65patients were concurrently present.Among them,the number of damp heat certificates is the largest,accounting for 64.6%.(3)3Distribution of primary disease:Among the 65 patients,the most common primary disease was chronic nephritis syndrome,a total of26 cases;followed by hypertensive renal damage,a total of 18 cases.(4)Distribution of risk factors:The number of patients with three risk factors combined was the highest among the 65 patients,And the largest number in each phase of CKD.(5)Evaluation of renal function progression:CKD2,CKD3a,CKD3b patients had no significant difference in eGFR,ACR,and level before and after enrollment(P>0.05);CKD3b patients had different BUN levels(P<0.05),and BUN levels were high after enrollment.Before joining the group.There were differences in eGFR,Scr and BUN between the CKD stage 4patients before and after enrollment(P<0.05).The eGFR level after enrollment was lower than that before enrollment,and the Scr and BUN levels were higher than before enrollment.(6)Risk factors control:CKD2,CKD3b,CKD4 patients had no significant difference in systolic blood pressure and diastolic blood pressure before and after enrollment(P>0.05),CKD3a patients before and after enrollment group systolic blood pressure levels(P<0.05),after enrollment level Higher than before the group.There were no significant differences in TC,TG and HDL-C levels between CKD2,CKD3a and CKD3b patients(P>0.05).There were differences in LDL-C levels between CKD4 and CKD2 patients before and after enrollment.The post-level was lower than that before enrollment;the TG level of CKD4 patients was different before and after enrollment(P<0.05),and the level after enrollment was lower than that before enrollment.There was no significant difference in SUA levels between CKD2,CKD3a and CKD3b patients(P>0.05).There was a difference in SUA levels between the CKD 4 patients before and after enrollment(P<0.05).(7)Efficacy index evaluation:The changes of eGFR in patients with CKD 2-4 before and after enrollment were less than4ml/min/m~2.There was no statistical difference between ACR levels before and after enrollment.The level after enrollment was higher than that before enrollment.There were 4 patients with significant renal function decline and 0 patients with end-stage renal disease.Conclusion:(1)Under the premise of basic treatment of Western m edicine,according to the patient's own risk factors for the pr ogression of chronic kidney disease(hypertension,hyperlipidem ia,hyperuricemia),the targeted use of TCM comprehensive nurse ry can be delayed to some extent.The progression of renal func tion in patients with CKD 2-4 had no significant intervention e ffect on urinary protein,serum creatinine,urea nitrogen,and blood uric acid levels in patients with CKD.(2)The basic treatme nt combined nursed back-up program has a certain intervention e ffect on blood lipid related indicators in patients with chroni c kidney disease,and the effect on blood pressure intervention is not obvious.(3)This study can not prove the independent effe ct of TCM comprehensive nursery program on risk factors.It is also necessary to continue the multi-center prospective cohort study to expand the sample size and set up the control group to confirm the intervention effect of TCM comprehensive nursery pr ogram on risk factors.Delayed progression of renal function.