| ObjectiveThe aim of this study is to retrospectively analyze the data of patients with diabetic kidney disease in our hospital from 2011 to 2016,to understand the survival of patients with diabetic kidney disease under the intervention of traditional Chinese medicine,and to analyze the related factors affecting their prognosis,so as to provide clues for clinical practice in the treatment of diabetic kidney disease.MethodsCollecting the cases of patients with diabetic kidney disease diagnosed as primary disease during hospitalization in Guangdong Hospital of Traditional Chinese Medicine from January 2011 to December 2016/31,and selecting the patients who used traditional Chinese medicine during the treatment and did not undergo renal replacement therapy at the time of diagnosis of diabetic kidney disease,excluding the time interval between diagnosis of diabetic kidney disease and entering renal replacement therapy less than three months or patients with unknown initial time point of diabetic kidney disease or those only with baseline follow-up data.Setting a composite endpoint including recepting renal replacement therapy or mortality and the relationship between factors and prognosis outcome of diabetic kidney disease was analyzed by logistic regression.Further grouping was made according to whether or not the Chinese patent medicine of hypoproteinuria was used,different CKD stages,whether or not ACEI/ARB was used,whether or not there was hematuria,whether there was massive proteinuria,different levels of hemoglobin and whether or not diuretics were used to compare the survival of the two groups.Cox regression was used to investigate the effects of traditional Chinese medicine for reducing urinary protein,CKD stage,ACEI/ARB,hematuria,massive proteinuria,hemoglobin level and diuretics on the prognosis of diabetic kidney disease.Results416 patients with diabetic kidney disease were enrolled,of which 155 were treated with renal replacement therapy,31 died,176 survived and 54 lost interviews.The results of cross-sectional single factor analysis showed that the application of Chinese patent medicines,hematuria,proteinuria,glycosylated hemoglobin,creatinine,potassium,calcium,uric acid,phosphorus,carbon dioxide,urea nitrogen,albumin,hemoglobin and the use of ACEI or ARB,other antihypertensive drugs,diuretics,anemia drugs,alpha ketoacids were associated with the occurrence of complex endpoints(P<0.05).The results of binary logistic regression analysis showed that patients with diabetic kidney disease with massive proteinuria had an increased risk of entering renal replacement therapy or death(OR=2.316,95%Cl:1.325-4.049),and patients with higher hemoglobin levels in diabetic kidney disease had a lower risk of entering renal replacement therapy or death(OR=0.980,95%CI:0.967-0.994).Survival analysis showed that the median survival time of 416 patients with diabetic kidney disease who entered renal replacement therapy or died under the intervention of traditional Chinese medicine was 27.53 months.①The median survival time(37.03 months)of the group with Chinese patent medicine for reducing urinary protein was longer than that of the group without Chinese patent medicine for reducing urinary protein(24.20 months)(P<0.05).Multivariate COX regression showed that the use of Chinese patent medicines for reducing urinary protein could reduce the risk of death or access to renal replacement therapy in patients with diabetic kidney disease(HR-0.694,95%Cl:0.492-0.973,P=0.034).After correction,the use of Chinese patent medicines for reducing urinary protein was still suggested as a protective factor for the prognosis of diabetic kidney disease(SHR=0.756,95%Cl:0.539-1.059,P=0.103).②According to different stages of CKD,the median survival time(33.03 months)of patients with CKD3-CKD4 diabetic kidney disease was longer than that of patients with CKD5 diabetic kidney disease(11.47 months)(P<0.001).Multivariate COX regression showed that the risk of death or renal replacement therapy increased with the progression of CKD(HR=2.320,95%Cl:1.726-3.119,P<0.001).③The median survival time(43.03 months)of diabetic kidney disease patients treated with ACEI/ARB drugs was longer than that of diabetic kidney disease patients without ACEI/ARB drugs(17.60 months)(P<0.001).Multivariate COX regression showed that diabetic kidney disease patients treated with ACEI/ARB had a lower risk of death or access to renal replacement therapy(HR=0.409,95%Cl:0.302-0.556,P<0.001).④The median survival time(39.3 months)of diabetic kidney disease patients without hematuria was longer than that of diabetic kidney disease patients with occult blood(20.3 months)(P=0.002).Multivariate COX regression showed an increased risk of death or access to renal replacement therapy in patients with diabetic kidney disease with hematuria(HR=1.553,95%Cl:1.136-2.123,P=0.006).⑤The median survival time(17.20 months)of patients with diabetic kidney disease with massive proteinuria was longer than that of patients without massive proteinuria(50.37 months)(P<0.001).Multivariate COX regression showed an increased risk of death or access to renal replacement therapy in patients with diabetic kidney disease with massive proteinuria(HR=1.859,95%Cl:1.314-2.630,P<0.001).⑥The median survival time(51.07 months)of patients with high hemoglobin level(HB>=100g/L)was longer than that of patients with low hemoglobin level(HB<100g/L)(14.90 months)(P<0.001).Multivariate COX regression showed that patients with diabetic kidney disease with low hemoglobin level(HB<100g/L)had an increased risk of death or access to renal replacement therapy(HR=2.402,95%Cl:1.692-3.411,P<0.001).⑦The median survival time(17.77 months)in the diuretic group was longer than that in the non-diuretic group(37.03 months)(P<0.001).Multivariate COX regression showed an increased risk of death or access to renal replacement therapy in diabetic kidney disease patients using diuretics(HR=2.058,95%Cl:1.505-2.814,P<0.001).ConclusionThe prognosis of diabetic kidney disease and the related factors affecting the prognosis are various.The use of traditional Chinese medieine,especially the traditional Chinese medicine for reducing urinary protein,has a positive effect on the prognosis of diabetic kidney disease.Proper use of traditional Chinese medicine for reducing urinary protein can improve the prognosis of diabetic kidney disease patients and delay the time of entering renal replacement therapy.High CKD stage,hematuria,massive proteinuria,low hemoglobin level and the use of diuretic are not conducive to the prognosis of diabetic kidney disease,but further authoritative research is needed to verify the specific situation and related mechanisms. |
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