Nvestigation On The Correlation Between Gastrointestinal Symptoms, Chinese Medicine Syndrome Differentiation And Hyperphosphatemia In Hemodialysis Patients

ObjectiveThe present study conducts a survey on the gastrointestinal symptoms, Chinese Medicine syndromes and levels of serum phosphorus, serum calcium, parathyroid hormone(PTH) in hemodialysis patients, aiming to investigate underlying correlation between gastrointestinal manifestation and hyperphosphatemia, and lay a preliminary foundation for regulating metabolism of calcium and phosphorus using traditional Chinese medicine(TCM) theory.MethodsEligible subjects undergoing maintenance hemodialysis in Guangdong Provincial Hospital of Chinese Medicine were enrolled in the study in the period from September to December,2013. Questionnaire survey was conducted using gastrointestinal symptoms rating scale(GSRS) and slef-regulating symptom information collection tool. According to the TCM syndrome diagnostic criteria of syndrome differentiation, TCM syndrome for each Patient was verified by two attending physicians. Gather the24hours dietary recall in order to understand the diets of patients. Blood examinations were conducted in clinical laboratory using blood samples prior to hemodialysis treatment. Statistical analyses were performed to investigate correlation between gastrointestinal symptoms, TCM syndromes and hyperphosphatemia.Results147subjects were enrolled. Among them there are143patients showed gastrointestinal symptoms. The incidence of gastrointestinal symptom in hemodialysis patients reached as high as98.6%. The incidence of abdominal pain, reflux, indigestion, diarrhea and constipation were54.5%,42.1%,91.7%, 51.7%and59.3%, respectively. Patients with TCM syndrome of spleen deficiency with dampness and turbidity and those without this syndrome has significant difference in indigestion incidence (P<0.05). GSRS score of the former was higher than the latter. The survey also showed that the incidence of hyperphosphatemia in hemodialysis patients was as high as61.2%(90/147), among whom there were89patiennts with gastrointestinal symptoms. And most patients with controlled serum phosphorus also complained of gastrointestinal symptoms(56/57). No correlation with hyperphosphatemia was established concerning gastrointestinal symptoms, TCM syndromes, gerders, age, primary diseases, complicatig diseases, drug taking, serum creatinine and other biochemical markers(P>0.05). The phosphorus intake from diet(B=0.004, Exp(B)=1.004) was one of the risk factors of hyperphosphatemia.Conclusion①Hemodialysis patients have high incidence of gastrointestinal symptoms, commonly presenting as indigestion, constipation and abdominal pain. Most of the gastrointestinal symptoms were mild, although a few of them have moderate or severe symptoms which might influence their quality of life.②Patients with TCM syndrome of spleen deficiency with dampness and turbidity complained more of indigestion, and severer on overall gastrointestinal symptoms, abdominal pain, indigestion, comparing to those with opposite TCM syndrome.③There was no sufficient evidence supporting gastrointestinal symptoms and TCM syndrome to be associated factors for hyperphosphatemia.④There was positive correlation between phosphorus intake from diet and hyperphosphatemia. Dietary control should be emphasized.