A Clinical Research Of Nonthyroidal Illness Syndrome In Advanced Chronic Kidney Disease Patients

Objectives: The study was conducted to investigate the efficacy of sodium bicarbonate(SB) and N-acetyl-cysteine(NAC) on nonthyroidal illness syndrome(NTIS) in patients with advanced chronic kidney disease(CKD), which was regarding to influnces on the progression of CKD to end-stage renal disease(ESRD),correction of NTIS and reduction in estimated glomerular filtration rate(eGFR), to explore feasible strategies for dealing with NTIS in CKD patients.Methods: All patients recruited in this study were from the Department of Nephrology, Second Affiliated Hospital to Nanchang University from January 1, 2014 to May 31, 2015, according to the inclusion and exclusion criteria. Patients with CKD stage 3-4 were selected and randomly assigned 1:1:1 to SB, NAC, or control group and received oral medication for a period of 18 weeks. Laboratory parameters and courses of disease development, including the progression of CKD to ESRD,correction of NTIS and reduction in eGFR were dynamically monitored. All the analyses were performed with the SPSS 17.0 software. Assessment of efficacy in delaying the progression to ESRD and correcting NTIS was studied using Kaplan-Meier survival method and Cox proportional hazards model. Analysis of variance of repeated measures was used to evaluate the changes in eGFR from baseline to 18 weeks.Results: 1. A total of 126 patients were included in this study and there were 3, 4,3 subjects failed to continue the clinic visit in control, SB and NAC group,respectively. 2. The crude Kaplan-Meier survival analysis of ESRD showed increased cumulative risks of all-cause ESRD in control group than in SB group [risk ratio(RR)1.97, 95% confidence interval(CI) 1.02-3.84, P = 0.045] and NAC group(RR 5.50,95% CI 2.23-13.57, P < 0.001). 3. The crude analysis of NTIS correction showed decreased cumulative incidence of NTIS in SB group [odds ratio(OR) 0.19, 95% CI0.04-0.89, P = 0.035] and NAC group(OR 0.09, 95% CI 0.02-0.38, P = 0.001)compared with controls. The Cox regression analysis of proportional hazards model demonstrated significantly different influences of placebo, SB and NAC on ESRDrisk and NTIS incidence, P < 0.05 respectively. 4. Variance analysis for eGFR at the end of treatment period displayed significantly decrease in controls than in SB(P =0.044) and NAC group(P < 0.001). eGFR was decreased more in SB group than in NAC group(P = 0.023). No obvious side effect was observed during the follow-up.Conclusions: SB and NAC are effective in delaying the deterioration of renal function and promoting the recovery from NTIS status in advanced CKD patients,and notably, NAC is superior to SB.