Analysis Of Related Factors Of Residual Renal Function Loss In Single-center Peritoneal Dialysis Patients And Study Of TCM Syndromes

Objective:The purpose of this study is to analysis the relevant factors of the loss of Residual renal function,and improve the understanding and protection of Residual renal function by collecting the general condition and clinical data of the patients in the peritoneal dialysis center of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.Through the study of TCM syndromes in patients with peritoneal dialysis,the distribution characteristics of TCM syndromes in patients with peritoneal dialysis can be understood and ideas will be provided for the treatment of residual renal function in patients with peritoneal dialysis by combining traditional Chinese and western medicine,in order to upgrade the patients’ survival quality and better guide clinical treatment.Methods:In this study,a nested case-control study was adopted.Patients who received the first peritoneal dialysis catheterization in the Department of Nephrology of the First Affiliated Hospital of Tianjin University of Chinese Medicine from October 1,2017 to September 30,2019 were selected as the study cohort for regular follow-up.Collect the patient’s gender,age and relevant results of laboratory test,the basic situation of the baseline(3 to 6 months after catherization for peritoneal dialysis),the clinical indicators and patients’ urine volume,RRF,and ultrafiltration volume during the follow-up period.Collect patients’ TCM symptoms and pulse and tongue promptly at the end of the observation and complete TCM syndrome differentiation under the guidance of the nephrologist.According to the residual renal function at the end of the follow-up,the patients were divided into the RRF group and the non-RRF group.The non-RRF group was taken as the case group,and the control group was matched 1:1 in the whole cohort.Finally,conditional binary Logistic regression was used to explore the related factors of the loss of residual renal function,and we can use IBM SPSS 24.0 statistical software to finish statistical description and analysis of the above data.Results:1.246 PD patients were included in this research,of whom 156(63.4%)were men and 90(36.6%)were women,aged 59(47,66)years.The primary diseases included diabetic nephropathy in 104 cases(42.3%),chronic glomerulonephritis in 101 cases(41.1%),hypertensive renal damage in 16 cases(6.5%),and other types in 25 cases(10.2%).2.In the distribution of the major symptoms in 246 patients,the most frequent was spleen and kidney qi deficiency symptom,with 96 cases(39.0%),followed by 77 cases(31.3%)of spleen-kidney Yang deficiency,35 cases(14.2%)of qi and Yin insufficiency,22 cases(8.9%)of Yin-Yang both deficient,and 16 cases(6.5%)of liver-kidney Yin insufficiency.The the most frequent superficial symptoms was water dampness syndrome(82 cases,33.3%).The other syndromes were damp-heat syndrome(50 cases,20.3%),blood stasis syndrome(47 cases,19.1%),drowning poisoning syndrome(39 cases,15.9%),and patients with no concomitant symptoms(39 cases,15.9%).3.In the case of symptoms of deficiency and externality,the distribution of water dampness is the largest in the syndromes of insufficiency of spleen and kidney Yang,and damp-heat are less.Dampness and heat were more distributed in the deficiency syndrome of Qi and Yin,while water dampness was less common.Drowning poison syndrome usually appear in Yin-Yang both deficient syndrome,and the patients with water dampness syndrome and no concurrent syndrome were less.In terms of both superficial and original deficiency syndrome,the spleen-kidney Yang insufficiency syndrome was further in the waterdampness syndrome,while the Qi and Yin deficiency syndrome was less common.In the damp-heat syndrome,the deficiency of Qi-Yin was usual,but the deficiency of spleen and kidney Yang was less.The number of insufficiency of Yin and Yang was more in the drowning poison syndrome,and the deficiency of spleen and kidney qi and spleen and kidney Yang were uncommon,the disparity was statistically significant(P < 0.05).4.The comparison of clinical data between patients showed that patients without RRF had higher rates of heart failure and heart failure events on admission than patients with RRF;The heart rate and average ultrafiltration volume of the non-RRF group were significantly higher than those of the RRF group,and the distribution of low transport type was less than that of the RRF group.The group without RRF on WBC level higher than that of RRF group,but the parathyroid hormone,GGTP(gamma glutamyl transpeptidase),serum total protein and albumin,total Kt/V,residual kidney Kt/V,standard CCr,baseline e GFR,RRF,24 h urine before the embedded tube and at the baseline and n PCR are lower than RRF group.Yin-Yang deficient syndrome is more in the group without RRF,the above differences are statistically significant(P < 0.05).5.Univariate analysis of conditional binary Logistic regression showed that the factors such as white blood cell count,serum total protein,serum albumin,uric acid,heart rate,ultrafiltration volume,whether or not the patients were admitted to hospital with heart failure,whether or not the patients were hospitalized with heart failure,and high triglycerides had statistical significance.Multivariate analysis showed that white blood cells [OR=1.444,95%CI(1.013,2.060)] and high triglyceride [OR=8.317,95%CI(1.506,45.917)] are risk factors for residual renal function loss in PD patients.Albumin[OR=0.752,95%CI(0.616,0.919)] and residual kidney KT /V[OR=0.074,95%CI(0.013,0.422)] are protective factors.Conclusion:1.The TCM syndromes of patients in this center are mostly mixed deficiency and real.The original insufficiency syndrome is usually because of the deficiency of Qi of spleen and renal,and in the superficial symptoms,the number of water dampness syndrome is maximum.2.Residual renal function and 24-hour urine volume of the study population went down over time,and the loss of RRF may be related to heart failure,high cholesterol,low albumin,inflammatory state and hyper filtration volume,but we have not found the significant relationship between the occurrence of peritonitis,combined diabetes mellitus and other factors and RRF loss.Albumin and high triglyceride is a risk factor for peritoneal dialysis patients with residual kidney function loss,albumin and residual kidney Kt/V is the protection factor.With the increase in leukocytes,patients had an increase in risk of loss of RRF.With the increase of albumin or residual kidney Kt/V,the risk reduced.Compared with patients with normal triglyceride levels,patients with high triglyceride levels had a higher risk of RRF loss.