Analysis Of Influencing Factors Of Early Decline Of Residual Renal Function In Patients With Peritoneal Dialysis And Its Relationship With TCM Syndrome Types

Objective: To investigate the related factors affecting the decline of residual renal function in peritoneal dialysis patients and their relationship with TCM syndrome types,so as to provide evidence for clinical protection of residual renal function in patients.Method 1.According to the inclusion and exclusion criteria,select patients with end-stage renal disease who started peritoneal dialysis at the Peritoneal Dialysis Center of Wuhan First Hospital from September 2017 to October 2019,and collect the general conditions and related laboratory indicators of the patients;2.Calculate the residual renal function of PD patients who were screened into this study when they started peritoneal dialysis and after one year of peritoneal dialysis,and calculate the percentage of residual renal function decline.The patients were divided into two groups according to the median of the percentage of residual renal function decline within one year;3.Two professional TCM physicians classified the patients in this study by TCM syndrome differentiation,and divided them into the main deficiency syndrome(spleen and kidney qi deficiency syndrome,spleen and kidney yang deficiency syndrome,liver and kidney yin deficiency syndrome,qi and yin deficiency syndrome,yin and yang deficiency syndrome)and combined syndromes(damp-turbidity syndrome,damp-heat syndrome,blood stasis syndrome,heat toxin syndrome,wind-movement syndrome,no combined syndrome);observe the distribution characteristics of TCM syndrome types of patients,and compare the differences in the early decline of residual renal function in patients with different syndrome types.4.Compare the differences in general conditions,laboratory indicators,and TCM syndrome types of patients with different levels of residual renal function decline,and analyze the relevant factors affecting the decline of residual renal function in peritoneal dialysis patients.Results 1.A total of 133 patients were included in this study,and the average value of the decline in residual renal function after one year of PD treatment was 41.8±29.7%;2.There was no statistical difference in age,height,weight,BMI,gender ratio,the proportion of people using RAAS blockers,peritoneal transport function,and the proportion of people with peritonitis among patients with different decline in residual renal function,P>0.05;original Patients with diabetic nephropathy had a greater decline in residual kidney function,P<0.05;3.Among the laboratory indicators,in different groups of RRF decline there was no significant difference in alkaline phosphatase(AKP),transglutaminase(γ-GT),blood urea nitrogen(BUN),blood uric acid(UA),carbon dioxide binding rate(TCO2),cholesterol(CHOL),glycerol Triester(TG),low-density lipoprotein(LDL),blood potassium(K),blood calcium(CA),blood phosphorus(P),parathyroid hormone(PTH),C-reactive protein(CRP),serum prewhite protein(PA),P>0.05;Compared with group A,patients with a larger decline in RRF(group B)had lower levels of hemoglobin(HB),serum albumin(ALB),RRF after one year,and urine output after one year,P<0.05;and higher levels of red blood cell distribution width(RDW),serum ferritin(SF),blood creatinine(SCR),P<0.05;4.The spleen and kidney qi deficiency syndrome(30.1%)and the spleen and kidney yang deficiency syndrome(27.1%)accounted for a relatively large proportion of the patients in this study.Among the concurrent syndromes,damp turbidity(34.6%)and blood stasis syndrome(23.3%)were the main types The dampness and turbidity syndrome accounted for a higher proportion in patients with spleen and kidney yang deficiency syndrome(50%)and spleen and kidney qi deficiency syndrome(47.5%),P<0.05;damp-heat syndrome accounted for a higher proportion in patients with qi and yin deficiency syndrome(31%),P<0.05,blood stasis syndrome accounted for the highest proportion in patients with Yin and Yang deficiency syndrome(47%),P<0.05;no concurrent syndrome accounted for a higher proportion of patients with spleen and kidney qi deficiency(25%),P<0.05.There was no statistical difference in the distribution of heat-toxin syndrome and wind-movement syndrome in this deficiency syndrome(P>0.05);5.According to the grouping of this deficiency syndrome,patients with spleen and kidney qi deficiency syndrome have a smaller decline in residual kidney function(31.19±25.59%),while those with yin and yang deficiency syndrome decline more rapidly(63.17±32.36%).The residual kidney function of patients with deficiency of both qi and yin syndrome decreased significantly faster than that of the other three syndromes(P<0.05).According to the grouping of concurrent syndromes,there was no significant difference in the RRF decline between the 6 groups of patients(P>0.05).6.The results of the multiple linear regression model showed that the decline of residual renal function in PD patients was negatively correlated with ALB(B=-1.750),and positively correlated with RDW(B=4.959)and SCR(B=0.35)(P<0.05).The binary logistic regression model showed that higher levels of hemoglobin(OR=0.945),albumin(OR=0.800),and no concurrent evidence(OR=0.042)were protective factors for residual renal function,;higher levels of red blood cell distribution width(OR=2.729),SCR(OR= 1.011)and diabetes(OR=8.126)are risk factors for residual renal function(P<0.05).Conclusion 1.The results of this study show that higher levels of hemoglobin,serum albumin and unmarked evidence are protective factors for residual renal function in patients with early peritoneal dialysis;higher levels of red blood cell distribution width,blood creatinine,and diabetic nephropathy are the residual kidney function risk factors in patients with early peritoneal dialysis: Clinically,adequate dialysis,reduction of toxin retention,improvement of anemia and malnutrition can be used to slow down the decline of residual renal function in patients with early peritoneal dialysis,especially for patients with diabetic nephropathy,pay special attention to these influencing factors.2.The Traditional Chinese Medicine syndromes of Peritoneal dialysis patients are characterized by the deficiency of the original and the actual of the syndrome.In this study,the primary deficiency syndrome of the patients was mainly spleen and kidney qi deficiency.PD patients with deficiency of both qi and yin and yin and yang showed a faster decline in residual kidney function than other patients.Among the concurrent syndromes,the main syndromes were damp turbidity,and there was no difference in the decline of residual kidney function between the concurrent syndromes.No concurrent evidence is a protective factor for residual renal function in patients with early Peritoneal dialysis.Clinically,while Western medicine is being treated,patients can be treated with Traditional Chinese Medicine syndrome differentiation,especially for patients with obvious symptoms(damp turbidity,damp-heat syndrome,heat toxin syndrome,blood stasis syndrome,wind-movement syndrome)symptoms,the use of warming kidney Chinese herbal medicines such as spleen,nourishing qi and nourishing yin,reducing dampness and reducing turbidity,promoting blood circulation and removing blood stasis,etc.,carry out individualized treatment with integrated traditional Chinese and western medicine to improve patients’ clinical symptoms and protect residual kidney function in early period of PD.