Etiological Evolution Of Chronic Kidney Disease In The Elderly And Treatment Methods Of Integrated Traditional Chinese And Western Medicine

Objective:With the development of economy in China and the rising incidence and prevalence of diabetes and hypertension in the population in recent years,the etiological composition of patients with chronic kidney disease may have changed when compared with the past.Chinese Medicine is the treasure of our country.The main purpose of this study is to define the etiological spectrum of CKD and to observe the efficacy and safety of therapy that combined the Chinese and western medicine in the treatment of CKD.Methods:The study is divided into three parts and the first part is the study of disease spectrum,through the analysis of the etiology of CKD patients in our hospital from 1990 to 1991,2009 to 2010 and 2018 to 2019,the etiological composition and evolution of CKD patients between the younger and middle-aged group and the elderly group were compared.The second part is evidence-based medicine research,Search the main Chinese and English databases online,which include CNKI,Wanfang database,VIP database,CBM and Medline,EMBase,the Cochrane Library,Web of Science,and screen the randomized controlled trials about comparisons of Tripterygium preparation combined with ACEI/ARB drugs(test group)and ACEI/ARB drugs alone(control group)in the treatment of diabetic nephropathy.a meta-analysis of the outcome indicators including the difference of serum creatinine,urea nitrogen,24-hour urine protein quantification before and after treatment,incidence of adverse events,and total effective rate of the included studies were performed.The third part is the observation of clinical curative effect,Divide the elderly patients with CKD3-4 in our hospital in recent 5 years into control group,Shenkang injection group and Shenkang injection combined with alprostadil group according to their situation of medication.Analyze the improvement of renal function and the overall remission rate before and after treatment.Results:In the first part of the disease spectrum study,The leading cause of CKD in 1990-1991,2009-2010 and 2018-2019 was chronic glomerulonephritis(52%),chronic glomerulonephritis(35%)and diabetes(36%)respectively.The distribution of the etiologies was totally different among the three cohorts(P<0.001).Compared with 1990 to 1991,the percentage of CKD related to diabetes(P=0.001)and hypertension(P=0.002)significantly increased,while chronic glomerulonephritis showed a downward trend(P<0.001).Among the elderly CKD patients,the leading cause of CKD in the three cohorts was chronic glomerulonephritis(34%),diabetes(40%)and diabetes(43%),and hypertension has become the second cause in 2009-2010 and 2018-2019.Among the younger and middle-aged patients with CKD,chronic glomerulonephritis remained to be the leading cause in the past 30 years,although the percentage declined gradually(P=0.103).In the second part,A total of 23 studies were included,with 1878 patients.Meta-analysis results show that:compared with the control group,the test group can significantly reduce the patient's serum creatinine(MD=-6.06,95%CI:-10.89?-1.22,P=0.01),24-hour urine protein quantification(MD=-0.70,95%CI:-0.87?-0.53,P<0.00001),increase the patient's serum albumin level(MD=2.83,95%CI:1.66?4.01,P<0.00001)and obtain a higher total effective rate of treatment(OR=3.05,95%CI:1.87?4.97,P<0.00001).But at the same time,the mean decrease level of white blood cells?the incidence of adverse events before and after treatment in the test group were higher than those in the control group.In the third part,the observation of the curative effect showed that there were no significant difference in the improvement of the renal function in the control group before and after treatment,but in Shenkang group the serum creatinine decreased by 21.04±34.35 umol/L,eGFR increased by 6.04±10.03 ml/min/1.73m2 and In the combined treatment group,the serum creatinine decreased by 27.23±25.03 umol/L and eGFR increased by 7.14±5.89 ml/min/m2.The total effective rates of the three groups were 18.0%,50.0%and 60.0%respectively(P=0.000)Conclusions:Diabetes is the leading cause of CKD at present.Diabetes and hypertension have become the leading causes of CKD in Chinese elderly patients.Although chronic glomerulonephritis was the leading cause among the younger and middle-aged patients with CKD,the percentage declined gradually.The combination of Chinese medicine immunosuppressants and ACEI/ARB drugs can achieve a higher total effective rate,but the treatment may also increase the incidence of adverse events,clinical use should be cautious The administration of Shenkang injection alone or in combination with alprostadil can significantly improve the renal function and obtain a higher total effective rate than general treatment in elderly patients with chronic renal insufficiency(CKD3-4).