Analysis Of Characteristic Of Traditional Chinese Medicine Syndrome And Its Relationship With Laboratory Parameter In Patients With Stage 5 Chronic Kidney Disease

[Background/Aim] In this article, the first, we reviewed the clinical characteristics and the related factors in patients with stage 5 chronic kidney disease (CKD). Here, the patients with stage 5 CKD mean the person with chronic renal failure (CRF) at renal failure or uremia stage. On the basis of clinical features and pathological mechanisms of stage 5 CKD, these patients were diagnosed the illness in Traditional Chinese Medicine (TCM) as "edema" or "retention of urine" or " obstruction and rejection" or "kidney consumption" or "wind due to dysfunction of kidney" or "lumbago" or "turbid dampness-toxicity". The related factors of stage 5 CKD include serum creatinine (Scr), blood urea nitrogen (BUN), residual renal function (RRF), proteinuria, hypertension, anemia, dyslipidemia, hyperuricemia, and water and electrolyte metabolism disorder. The second, we discussed the effects and mechanisms of Chinese herbal medicine for delaying the progression of renal dysfunction in stage 5 CKD patients. Initial time of dialysis and dialysis-related complications in the patients with stage 5 CKD were ameliorated through the treatment with combination of traditional Chinese and Western medicine, including oral administration or coloclysis of Chinese herbal medicine, oral administration combined with coloclysis of Chinese herbal medicine, and colonic dialysis combined with coloclysis of Chinese herbal medicine. Chinese herbal medicine ameliorated renal dysfunction including glomerulosclerosis and renal interstitial fibrosis by improving glomerular hemodynamics turbulence, podocyte injury, transforming growth factor (TGF)-βover-expression, hyperlipidemia, macrophage infiltration, tubular epithelial myofibroblast transdifferentiation, and nephrotoxicity of proteinuria. And that, it improved metabolic dysequilibrium of calcium and phosphonium, microinflammatory state, and uremic toxins in patients with uremia. The third, as a focal point in this article, it is reported that analysis of characteristic of TCM symptom and its relationship with laboratory parameter in patients with stage 5 CKD. The aim of this study is to anlyze the characteristic of TCM syndrome and its dependence with laboratory indexe in stage 5 CKD patients, for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in CKD. [Methods] The traditional retrospective method commonly used in epidemiological investigation was established. Data from 100 patients with stage 5 CKD were collected, and analysis between TCM symptoms and laboratory parameters, such as Scr, BUN, RRF, urine volume (UV), hemoglobinassay (Hb), red blood cell count (RBC), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum albumin (Alb), serum uric acid (SUA), potassium (K+), sodium (Na+), calcium (Ca2+), and phosphonium (P3+). [Results] In 47 non-hemodialysis patients with stage 5 CKD, the TCM symptoms included fatigue, aching loins and knees, dry mouth and throat, trichomadesis and loose teeth, aversion to cold and favor to warm, edema, indigestion and bloating, dizziness and tinnitus, dizziness and tinnitus, nausea and vomiting, dark lips and fingernail, etc. In which, the highest rate of the patients with deficiency of both qi and yin type was 57.4%. In 53 hemodialysis patients with stage 5 CKD, the TCM symptoms included anorexia and oliguria, aversion to cold, abdominal cold and liking hot drinks, constipation, dry mouth and throat, white and black face, dizziness and tinnitus, trichomadesis and loose teeth, etc. In which, the highest rate of the patients with Pi-Shen yang deficiency type was 62.3%. During the follow-up period, the level of RRF and UV was significantly lower and the level of TC, LDL-C, P3+, BUN, Scr, and SUA was higher in stage 5 CKD hemodialysis patients with Pi-Shen yang deficiency type compared with the patients with other TCM symptom type (P<0.05). [Conclusion] For 47 non-hemodialysis patients with stage 5 CKD, deficiency of both qi and yin is the major clinical characteristic of TCM, however, for 53 hemodialysis patients, it is Pi-Shen yang deficiency type. The level of RRF, UV, TC, LDL-C, and P3+, which is related to Pi-Shen yang deficiency type, could be taken as one of the relative factors for the syndrome type. Besides, deficiency of both Pi and Shen is the basic mechanism of disease in stage 5 CKD patients. For non-hemodialysis patients with stage 5 CKD, there is no relationship between TCM syndromes and laboratory parameters.