| Recently, epidemiological survey suggests that the incidence of chronic kidney disease(CKD) increased year by year. A study from the U.S. National Institutes of Health showed that, in1999～2004, the prevalence of chronic kidney disease in adults over the age of20reached13%, which was30%higher than that in1988～1994. The main Western medicine treatment for the early stage of CKD is to control kidney damage aggravating factors, treat the primary disease, and the symptomatic treatment of complications, but the impairment of kidney function will continue to progress, and eventually develops into end-stage kidney disease and have to rely on renal replacement therapy. At present, the main renal replacement therapies such as hemodialysis, peritoneal dialysis and kidney transplant are expensive and easy to cause a variety of complications, while large number of clinical studies have showd that Chinese herbal colon dialysis therapy can lower uremic toxins lever in serum of CKD patients, control the progress of renal dysfunction, and improve the quality of patients’life.Objective:The Study is designed to establish a simple and specific method to determine the concentration of indoxyl sulfate (IS) in serum, analyse the correlation among IS and other uremic toxins, and observe the effect of Chinese herbal colon dialysis therapy of CKD stage3-5patients in aspects of uremic toxins in serum and clinical symptom, to explore the mechanism of the method and to evaluate its clinical application.Methods:(1) The experimental conditions were as follows:The human serum was disposed by0.2%trifluoroacetic acid-acetonitrile(10:90) for precipitating protein, the mobile phase consisted of sodium dihydrogen phosphate (adjusted to pH2.5with trifluoroacetic acid)-acetonitrile(92:8) at the flow rate of1.0mL·min-1, the detection wavelength:excitation wavelength was set at280nm, emission wavelength was set at390nm.(2) In the study, the31Chronic Kidney Disease stage3-5patients were divided into two groups according to their own will whether to accept Chinese herbal colon dialysis therapy,16paitents in control group,15paitents in treatment group. All patients were given conventional western medicine treatment, and the oral traditional Chinese medicine (TCM) according to TCM syndrome differentiation; and the patients in treatment group were additionally treated by Chinese herbal colon dialysis therapy for3times a week(once every other day). Both of the two groups are observed for2 curative courses, which last for1months, in order to observe the variation of clinical syndrome, experiment indexes such as IS, serum creatinine(SCr), blood urea nitrogen(BUN), glomerular filtration rate(GFR) in the patients. The statistics were processed SPSS17.0statistical software, and P<0.05for statistical significance.Results:(1) The method of high performance liquid chromatography with fluorescence (HPLC-FLU) detector can accurately determine the concentration of IS in serum, and IS has high positive correlations with SCr and BUN. IS in CKD patients is significantly higher than that in normal persons.(2) Both of the two groups improved the clinical symptoms obviously after treatments, and the clinic effect in the treatment group was superior to that in the control groups.(3) There was significant difference in SCr between before and after treatments on both groups(P<0.05), and both of the two groups gained significant increase in eGFR level(P<0.05).(4) Treatments group had lower IS level after Chinese herbal colon dialysis therapy(P<0.05), while control group with no significant difference after treatments (P>0.05).(5)The two groups had no significant difference in BUN, UA level between before and after treatments (P>0.05).(6) Before and after treatments, both of the two groups had no obvious adverse reaction, and the safety indexes had no significant difference.Conclusions:The method of HPLC-FLU detector can accurately determine the concentration of IS in serum, and IS in CKD patients has high positive correlations with SCr. Chinese herbal colon dialysis therapy can improve clinical symptom of CKD stage3-5patients, reduce uremic toxins such as IS, SCr, and increase eGFR without adverse events. The results show that Chinese herbal colon dialysis therapy is safe and effective, and has high value in clinic. |
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