The Influence Of Traditional Chinese Medicine (TCM) On Survival Of Patients Undergoing Peritoneal Dialysis And Its Mechanism

Objective:1. In the clinical, to analyze the current situation of patients undergoing peritoneal dialysis and the factors affecting the survival of these patients by reviewing data from Hospital of TCM in Guangdong Province. Peritonitis, tunnel infection or other abdominal infection, turning to other renal replacement therapy or death were defined as the end point events. According to receiving Traditional Chinese Medicine or not, all the patients were classified into the TCM treatment group or the control group. The survival situation and influencing factors of different groups were contrasted too.2. In the experiment, to observe the effect of Ginseng saponin and Panax notoginseng saponnins on the cytotoxicity of human peritoneal mesothelial cells (HMrSV5) which injured by peritoneal dialysis fluid (PDF) and compare the differences in expressing Smad protein and gene of these groups.Methods:1. In the clinical, the data on maintenance PD were obtained retrospectively from 2011 to 2015. We analyzed the patient survival rate by using The Kaplan Meier method and life table method. The Cox proportional hazards method were applied for measuring the risk factors and calculating their hazard ratio for patient mortality. Different groups’survival details were on comparison.2. In the experiment, the survi val rate was detected by MTT after the HMrSV5 cells buffering by 2.5%-L-PDF (G2.5 PDF) or 4.25%-L-PDF (G4.25 PDF) for 1 hour, 2 hours and 3 hours. The final model used the G2.5 PDF as the buffer intervening HMrSVS cells for 1 hour. The proliferation and LDH of HMrSV5 cells were examined by MTT assay and automatic biochemical analyzor, the expression of Smad were detected through Westerenblot and RT-PCR.Results:1. In the clinical, totally 158 patients were recruited in the study. The major reasons for renal failure were Glomerulonephritis(30.38%) and Diabetic nephropathy(22.15%).54(34.18%) patients came to the end point events during the study. Taking the peritoneal infection as the main end point event, the median of survival time was 30 months (95%CI:28,32) for all patients. In the TCM treatment group, the median of survival time was 46 months (95%:22, 70), while the control group’s median survival time was 29 months (95%CI: 28,30). The 1,2,3,4 years of survival rate in all patients were 82.00%, 65.00%,38.00%,19.00, while in the TCM treatment group were 80.00%,66.00%, 57.00%,28.00. The 1,2,3 years of survival rate in the control group were 83.00%,64.00%,19.00%. The Cox analysis showed that anemia(HR 3.34,95%CI 1.05,10.60,P=0.04), serum albumin(HR 0.81,95%CI 0.71,0.92, P=Q.001), hypoalbuminemia(HR0.17,95%CI0.03,0.82, P=0.03),24 hours urine protein(HR 1.00,95%CI1.00,1.00,P=0.04), urea (HR1.07,95%CT1.01,1.14,P=0.02), the Kt/V level(HR0.29,95%CI0.09,0.97, P=0.04) may be its risk factors. Taking renal replacement therapy changing as the main end point event, the median of survival time was 46 months (95%CI:29,63) for all patients. In the TCM treatment group, the median of survival time was 46 months (95%:22,70), while the control group’s median survival time was 32 months (95%CI:22,42). The 1,2,3,4 years of survival rate in all patients were 93.00%,76.00%,58.00%, 29.00, while in the TCM treatment group were 93.00%,74.00%,69.00%,35.00. The 1,2,3 years of survival rate in the control group were 93.00%,78.00%, 45.00%. The Cox analysis showed that serum albumin{HR0.79,95%CI0.65,0.97, P=0.02), urea(HR1.17,95%CCI1.04,1.32,P=0.01), the Kt/V level(HR0.07,95%CI 0.007,0.64,P=0.02) may be its risk factors.2. In the experiment, for G2.5 PDF buffer groups, the cells’survival rate of 1 hour,2 hours,3 hours was 43.18%,21.25%and 23.67%. For G4.25 PDF buffer groups, the cells’survival rate was 31.82%,19.50%and 22.00%in the same time period. MTT showed that Ginseng saponin could effectively reduce the apoptosis in vitro at a dose-independent of 75μg/ml, while the Panax notoginseng saponnins at a range of 50-75μg/ml. The drug groups showed reduction in the express of Smad3 protein, but no difference in Smad protein and Smad gene.Conclusion:1. In the clinical, serum albumin, urea, urine protein and the Kt/V level are all risk factors to the survival of peritoneal dialysis. By improving the nutritional status, controlling serum albumin, avoiding hypoalbuminemia, reducing proteinuria can help the PD patients with better health and increase their survival. Although no significant difference found in the survival of both groups, the long term survival of TCM treatment group may be better than the control one according to the current results.2. In the experiment, as more glucose in the PDF for stimulating more time, there were less cells survived. Ginseng saponin and Panax notoginseng saponnins could help to reduce the cytotoxicity. Their roles might relate with the effct of TGFβ-Smad signaling pathway.