| Objective 1.To observe the differences in glucose exposure,blood glucose control,peritoneal transport function,and distribution of TCM syndrome types between patients with diabetic nephropathy(DN)and non-diabetic nephropathy(NDN),and to guide the diabetic and non-diabetic patients Chinese and western medicine treatment plan.2.The distribution and changes of sugar exposure received by dialysis kidney ESRD patients during peritoneal dialysis and its impact on changes in peritoneal transport function and peritonitis,in order to guide the adjustment of dialysis schedule for dialysis kidney.Methods Part I Peritoneal transport and TCM syndromes of diabetic nephropathy and non-diabetic nephropathy The subjects of this study were selected from July 2019 to October 2019.Patients with maintenance peritoneal dialysis(MPD)who were regularly followed up in the dialysis center of Wuhan First Hospital.Inclusion criteria: Patients with end-stage renal disease who underwent maintenance peritoneal dialysis at Wuhan First Hospital with a dialysis age of> 3 months;signed informed consent;exclusion criteria:(1)age <16 years;(2)due to hearing and language,Intelligence,mental factors and other reasons can not cooperate with patients with TCM syndrome differentiation;(3)general conditions and clinical data are incomplete;(4)patients undergoing hemodialysis at the same time.The differences of general conditions,biochemical indexes,blood glucose,peritoneal transport characteristics,and TCM syndrome type distribution between patients with and without diabetes were compared.Part II Sugar Exposure and Peritoneal Transport Characteristics in Patients with Diabetic Nephropathy In this study,patients with end-stage renal disease who were regularly followed up in the dialysis center of Wuhan First Hospital from 2013 to October 2019 were selected to have diabetic nephropathy.The end point of follow-up was October 31,2019.Inclusion criteria: Patients with maintenance peritoneal dialysis who meet the diagnostic criteria for diabetic nephropathy.The patient signed an informed consent and cooperated with the investigation.Exclusion criteria: patients who could not be followed regularly due to various factors,such as in the field(interval of follow-up> 6 months).Incomplete medical records or baseline biochemical indicators and peritoneal balance test data.Observe the changes in glucose exposure and peritoneal transport characteristics in patients with diabetic nephropathy,and the causal relationship between the two;observe the correlation between glucose exposure and fasting blood glucose.ResultsPart I A total of 70 patients were included in this study.All patients were divided into two groups: diabetic nephropathy(DN)group and non-diabetic nephropathy(NDN)group.The results of the grouping study showed that: 1.Blood glucose levels: The blood glucose level was higher than the NDN group,and the difference between the two groups was statistically significant(P <0.01);the sugar exposure in the DN group was 78.76 ± 31.02,which was significantly lower than the NDN group 94.5 ± 30.64(P <0.05).2.Dialysis-related indicators: The median residual renal Kt / V and mean residual Ccr of NDN patients were higher than those of DN patients(P> 0.05);the 4h D / P value of DN was 0.72 ± 0.13 significantly higher than that of NDN group(P <0.05).3.Peritoneal transport type: HA(50%)and LA(42.11%)are the main types in the NDN group,that is,high average transport and low average transport are comparable,while HA(43.75%)accounts for the highest proportion in the DN group,and LA(25%))And H(25%)are next(p = 0.08).4.TCM Syndrome Types: TCM Syndrome Types are Qi and Yin Deficiency,Spleen and Kidney Yang Deficiency,and Yin and Yang Deficiency Syndrome Type 3.Among them,37 cases of deficiency of qi and yin accounted for the highest proportion(52.86% in total,46.88% in NDN group,57.89% in DN group),followed by 34 cases of deficiency of spleen and kidney yang(34.29% in total,37.5% in NDN group,The DN group accounted for 31.58%),with the smallest number of patients with yin and yang deficiency syndrome,a total of 9 cases,5 cases in the NDN group,and 4 cases in the DN group(P> 0.05).4.Blood sugar and TCM syndrome types: Hb A1 c <6.5% Qi and Yin deficiency accounted for 74.07%,Spleen and Kidney deficiency syndrome was 87.88%,Yin and Yang deficiency syndrome was 33.33%, and the glycated hemoglobin compliance rate of the Yin and Yang deficiency syndrome group was the other two.There was a statistically significant difference between groups(p <0.001).5.Transport types and TCM syndrome types: There was no statistical difference in the distribution of syndrome types between different transport characteristics groups(p = 0.98).Part II A total of 24 patients with ESRD with diabetic kidney were included in this study.The male to female ratio was 1.4: 1.The average age of onset of peritoneal dialysis was 56.04 ± 10.34 years.Eight patients died during follow-up.Seven of the deaths were due to cardiovascular events.1 case was unknown;4 cases were transferred to hemodialysis,the causes were peritonitis(2 cases),poor catheter function(1 case),and unknown(1 case).1.The baseline high-transportation group had significantly lower hemoglobin and blood calcium,while the aspartate aminotransferase and dialysis creatinine clearance rates were significantly higher than those of the low-transportation group(P <0.05).LA accounted for 40.62%,followed by HA accounted for 36.46%,and L and H accounted for the least,both 11.46%.2.The baseline D / P value was 0.63 ± 0.13.With the delay of treatment time,the D / P value changed significantly: 0.62 ± 0.13 in the first year vs 0.70 ± 0.13 in the second year vs 0.65 ± 0.12 in the third year(P> 0.05)).3.Dividing patients into D / P increasing group and stable group: the baseline D / P value(0.53 ± 0.11)of D / P increasing group was lower than D / P stable group(0.72 ± 0.08)(P = 0.11);increasing The D / P value of the patients in the group was gradually increased from the lower level of transport,while the D / P value of the stable group was gradually decreased.4.Sugar exposure: The average annual sugar exposure is 49.30 ± 13.23 kg / year,the minimum exposure is 10.95 kg,and the maximum exposure is 76.65 kg.With the extension of the peritoneal dialysis treatment time,the annual sugar exposure gradually increases,but there is no statistics.Difference(P> 0.5).5.The average fasting blood glucose during follow-up within 3 years was 9.75 ± 4.46 mmol / l,and there was no significant correlation between fasting blood glucose and glucose exposure in the same year.6.There was no statistical difference in baseline fasting blood glucose between the D / P stable group and the D / P increasing group,and the fasting blood glucose showed an upward trend.The fasting blood glucose level of the increasing group in the first 3 years was higher than that of the stable group(P> 0.05).7.The patient’s baseline D / P was positively correlated with the amount of sugar exposed.The lower the baseline transport capacity,the higher the amount of sugar exposed during treatment(year 1: β = 42.20,R2 = 13.3%,P = 0.08;the first two years: β = 62.75,R2 = 15.1%,P = 0.06;the first 3 years: β = 0.79.71,R2 = 12.4%,P = 0.09);changes in 4h D / P and sugar exposure during peritoneal dialysis during 8.3 years,Baseline D / P was related to albumin(P <0.05),and the decline in peritoneal transport capacity in patients with high transport was closely related to albumin(P <0.05).8.There was no significant correlation between sugar exposure and the incidence of peritonitis.Conclusion 1.Diabetic patients with dialysis nephropathy have higher blood glucose levels and peritoneal solute transport capacity than non-glycemic kidney patients;MPD patients have TCM syndromes of qi and yin deficiency,spleen and kidney yang and yin and yang deficiency type 3,and qi and yin deficiency Mainly,the proportion of qi-yin deficiency syndrome in patients with sugar kidney is higher than that in patients without sugar kidney;there is no significant correlation between TCM syndrome types and blood glucose levels and peritoneal transport types.Clinically,based on Western medicine treatment,according to whether MPD patients are diabetic nephropathy,strengthen the yin and yang tonic,nourish liver and kidney therapy as appropriate,and promote blood circulation,remove stasis,remove dampness and turbidity,etc.,according to its combination of syndromes,to achieve integration of traditional Chinese and western medicine.Individualized treatment.2.Patients’ peritoneal solute transport capacity within 3 years is closely related to sugar exposure,baseline transport capacity,and albumin;among them,patients with high solute transport capacity gradually reduce transport capacity over time,mainly affected by albumin,and sugar exposure The inflammatory response is related;patients with low solute transport capacity tend to gradually increase transport capacity,but the increase in transport capacity within 3 years is not significantly affected by sugar exposure.It is suggested that the early peritoneal transport capacity of clinical patients is not directly affected by sugar exposure,and it is more important to prevent the indirect inflammatory reactions and adverse reactions caused by malnutrition. |
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