Study On Risk Factors Of Chronic Kidney Disease Complicated With Gastrointestinal Dysfunction And Distribution Rule Of Tcm Syndromes Based On The Theory Of "Gut-kidney Axis"

Objective:This subject is a retrospective study by collecting the general data,relevant laboratory and examination indexes of the inpatients who were diagnosed by chronic kidney disease（CKD）.This study explores the risk factors of CKD complicated with gastrointestinal dysfunction（GD）by analysing the data of CKD inpatients.The results of this study can provide the data to clinical treatments,slow the progression of CKD and improve the comfort of CKD inpatients.Trying to explain the pathogenesis of CKD complicated with GD from the standpoint of Gut-kidney axis.This paper shows the distribution of TCM syndrome types which can provide reference for clinical TCM diagnosis and treatment.Methods:The inpatients were diagnosed by CKD and did not apply the renal replacement therapy.The CKD inpatients were hospitalized in Nephrology Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from October 2019 to October2020.Collecting the general data,relevant laboratory and examination indexes and the information of the four diagnostic methods of TCM of the CKD inpatients.According to the complications of GD（irritable bowel syndrome,functional bloating,functional constipation,functional diarrhea,unspecific functional bowel disorder）,the CKD inpatients were divided into two groups:the concurrent group and the uncurrent group.By sorting out the data of the CKD inpatients and applying the SPSS statistical software,this paper will conclude the risk factors of CKD complicated with GD and the distribution rule of TCM syndromes.Results:1.This study took in 381cases.This study had 211 male inpatients（55.38%）and 172female inpatients（44.62%）.The average CKD course of 381 CKD inpatients was 6.25years.The result of CKD stages distribution was 73cases（19%）in CKD phase1,48cases（12%）in CKD phase2,71cases（19%）in CKD phase3,57cases（15%）in CKD phase4 and132cases（35%）in CKD phase5.According to TCM syndrome,381 cases was divided into the deficiency syndrome which had 235cases and the excess syndrome which had 146cases.The deficiency syndrome included 93cases（40%）yang insufficiency of the spleen and the kidney,41cases（17%）qi insufficiency of the spleen and the kidney,38cases（16%）qi yin insufficiency of the spleen and the kidney,and 38cases（16%）yin insufficiency of the liver and kidney.The excess syndrome included 54cases（37%）damp-heat syndrome,48 cases（33%）damp-turbidity syndrome,37 cases（25%）water-gas syndrome and 7 cases（5%）blood stasis syndrome.2.This study took in 381cases which were divided into the concurrent GD group which had 237cases（62.20%）and the uncurrent GD group which had 144cases（37.80%）.Compared of general situation between the concurrent group and the uncurrent group,the difference between two groups was not statistically significant（P>0.05）.Compared of the age of two groups,the uncurrent GD group was younger than the concurrent GD group which was statistically significant（P<0.01）.The median CKD course of two groups was 4years.The difference of CKD course between two groups was not statistically significant（P>0.05）.The diabetes morbidity of the concurrent GD group was higher than the uncurrent GD group’s which was statistically significant（P<0.01）.With the development of CKD,the CKD complicated with GD morbidity of the concurrent GD group is higher the uncurrent GD group’s which was statistically significant（P<0.01）.The level of Scr,UREA,K,P,iPTH of the concurrent GD group is higher the uncurrent GD group’s which was statistically significant（P<0.01）.The level of GFR,TC,TG,HGB,24h-Upro,Ca,CO₂CP of the concurrent GD group is lower the uncurrent GD group’s which was statistically significant（P<0.01）.The difference of the level of ALB between two groups was not statistically significant（P>0.05）.Compared of HUA morbidity between two groups,female inpatients were more than male inpatients which was statistically significant（P<0.01）.The HUA morbidity of the concurrent GD group was higher than the uncurrent GD group’s which was statistically significant（P<0.01）.3.The age,diabetes morbidity,HUA morbidity,the level of Scr,UREA,P,iPTH were positively correlated with CKD complicated with GD.GFR,CO₂CP,TG,HGB,24h-Upro were negatively correlated with CKD complicated with GD.The risk of CKD complicated with GD in above 60-year-old inpatients was higher than that in under 60-year-old patients（OR=2.911,95%CI=1.892-4.479）.The risk of CKD complicated with GD in patients with diabetes was higher than that in patients with normal blood glucose（OR=3.158,95%CI=1.945-5.130）.The risk of CKD complicated with GD in patients with HUA was higher than that in patients with normal uric acid（OR=1.604,95%CI=1.056-2.438）.The independent risk factors for CKD complicated with GD patients were Scr（OR=3.239）,UREA（OR=3.928）,P（OR=3.286）,iPTH（OR=2.136）.4.Compared of the TCM syndrome between the concurrent GD group and the uncurrent GD group,the difference between qi insufficiency of the spleen and the kidney and yang insufficiency of the spleen and the kidney,yin insufficiency of the liver and kidney,yin yang insufficiency of the spleen and the kidney was statistically significant（P<0.01）.The difference between other two TCM syndromes was not statistically significant（P>0.05）.The distribution rule of deficiency syndrome during CKD stages,there were 14cases（5.96%）of qi yin insufficiency of the spleen and the kidney in CKD phase1,10cases（4.26%）of yin insufficiency of the liver and kidney in CKD phase2,27cases（11.49%）of yin insufficiency of the liver and kidney in CKD phase3,12cases（5.11%）of yin insufficiency of the liver and kidney in CKD phase4,34cases（14.47%）of yin insufficiency of the liver and kidney in CKD phase5.The distribution rule of the excess syndrome during CKD stages,there were12cases（8.22%）of water-gas syndrome in CKD phase1,8cases（5.48%）of damp-turbidity syndrome in CKD phase2,13cases（8.90%）of damp-heat syndrome in CKD phase3,12cases（8.22%）of damp-turbidity syndrome in CKD phase4,20cases（13.70%）of damp-heat syndrome in CKD phase5.Conclusions:1.The morbidity of CKD complicated with GD in this study was 62.2%.2.The deficiency syndrome of CKD complicated with GD was mainly based on yang insufficiency of the spleen and the kidney.The excess syndrome of CKD complicated with GD was mainly based on damp-heat syndrome.3.The risk factors for CKD complicated with GD patients were age,CKD stages,Scr,UREA,GFR,P,CO₂CP,TG,HGB,24h-Upro,iPTH.The independent risk factors for CKD complicated with GD patients were Scr,UREA,GFR,P,CO₂CP,TG,HGB,iPTH.