| BackgroundChronic renal failure(CRF) is the common result of progressing chronic kidney disease (CKD). It can further develop to end-stage when transplantation or dialysis is required if not properly and timely treated. Patients on dialysis spend large amount of medical cost to maintain their lives with decreased quality. Therefore, efforts to slow the progression of CRF have always been of great value both clinically and financially. Traditional Chinese Medicine (TCM) plays an important role in the treatment of pre-dialysis CRF patients. Chinese herbal enema therapy by the principle of "inducing wastes excrete from the gut" has been widely applied and reported to be capable of reducing uremic toxin accumulation such as serum creatinine and urea.Indoxyl sulfate(IS), a typical albumin-binded uremic toxin, has been proved to be an accelerator of complications and progression of CKD. Elimination of IS is believed to have beneficial effect on prognosis. It is metabolized by the liver from indole, which is produced from food tryptophan by intestinal flora. We can easily understand that it is also an enterogenic toxin. IS starts to accumulate in CRF patients early from stage 3 as reported. Effective measures to eliminate it are limited so far, as even hemodialysis can only clear a small proportion of accumulated IS. Chinese herbal enema therapy is directly exerted to the intestine where IS derives. We have reasons to assume that this therapy may reduce IS accumulation and bring potential better clinical results. ObjectiveTo objectively assess the true value of Chinese herbal enema therapy in the treatment of chronic renal failure patients in aspects of clinical efficacy, safety,compliance and prognosis. Probable correlations between typical uremic toxins, especially indoxyl sulfate and TCM syndromes are also probed.Methods117 in-patients from Nephrology Dept. of Guangdong Provincial Hospital of Chinese Medicine were enrolled in this prospective clinical study in the period from March to December,2010. After 21 of them were excluded by criteria, others were grouped according to their own will whether to accept enema therapy or not, defined as Group A (treatment) and Group B (control). All patients were given basic treatment by clinical path, except that patients in group A were additionally treated with Chinese herbal enema therapy for 2 weeks. Variances on symptoms, uremic toxin levels (BUN, SCr, UA, IS) and eGFR between before and after enema treatment were observed and analysed. The Chinese herbal enema therapy was comprehensively assessed by its clinical efficacy, safety and compliance, including a period of follow-up. We further probed the probable correlation between IS and TCM syndromes such as damp, heat, blood stasis, etc.ResultsAfter stratification, the two groups were well balanced in all conditions including age, sex, basic disease and kidney function,etc. Data showed that patients in Group A had lower serum IS level after treatment compared with that of patients in Group B with significant difference(p<0.05). Moreover, patients in Group A gained significant decrease in serum creatinine, urea, IS after enema therapy(p<0.01), which was absent in Group B. The effective percentages of Group A and B were 84.3%,50.0%, respectively. Clinical symptoms were relieved in both groups, especially symptoms of anorexia, nausea, and backache were better relieved in Group A, with significant difference (p<0.05). Results of follow-up showed that the percentages of not reaching endpoints within 6 months were 71.8% and 61.0%, in Group A and B respectively, though without significant difference. For patients of stage 5 CKD, Group A seemed to have advantage on percentage of not reaching endpoints than Group B (67.4% vs 26.5%).84.5 percent of patients showed satisfactory compliance to the enema therapy. No severe adverse event was reported throughout the research, and drop-off cases were less than 10%.Analysis on TCM syndromes of the included patients indicates that the accumulated creatinine is correlated to some extend with syndrome of damp-heat or dampness; while indoxyl sulfate has closer relationship with damp-heat than any other TCM syndromes.ConclusionChinese herbal enema therapy in addition to the comprehensive treatment of CRF, helps improve the overall clinical efficacy. It further ameliorates clinical symptoms, reduces accumulation of uremic toxins such as creatinine, urea, especially indoxyl sulfate. It has potential benefits on slowing the progression of CRF or delaying the initiation of dialysis. Most patients showed well tolerance of this therapy for 1-2 weeks without severe adverse events. Therefore, Chinese herbal enema therapy deserves more emphasis for its great importance for the comprehensive treatment of chronic renal failure.
|
PDF Full Text Request