| ObjectiveThe purpose of this study was to investigate the occurrence of functional constipation in maintenance hemodialysis patients,to analyze the related factors,to explore the characteristics of TCM syndromes,and to observe the effect of Dahuang(Rheum Officinale)-Huanglian(Coptis Chinensis)Granule Compund on their symptom,serum levels of enterogenic uremic toxins and quality of life for hemodialysis patients with constipation and TCM syndrome of Intestinal Excess-Heat.MethodsA single center cross-sectional survey was conducted in Hemodialysis Department of Guangdong Provincial Hospital of Chinese Medicine in March 2016.A questionnaire was designed to collectpatients' bowel movements,eating habits(fruits,vegetables,drinking water)and exercise habits.Other clinical data was obtained from our hemodialysis center information registration system,including demographic characteristics(age,gender,primary disease,age of dialysis,dry weight,body mass index,etc.),parameters of the dialysis,dialysis frequency,time of treatment,ultrafiltration volume,etc.),complications(anemia,calcium and phosphorus metabolism disorder,etc.)and drug use(mainly phosphate binders).Also,information for TCM syndrome diagnosis was collected.The association of TCM syndromes and serum levels of enterogenic uremic toxins was analyzed.Then we performed a small sample interventional study.Dahuang-Huanglian Granule Compund was offered to constipated patients with Intestinal Excess-Heat for four weeks.The changes of their symptom,serum levels of enterogenic uremic toxins and quality of life was assessed.ResultsIn this study,206 hemodialysis patients were investigated,193 of them responded and the response rate is 93.7%.Of them,6 patients were excluded for they had a history of partial resection of the gastrointestinal tract,and 3 for having been diagnosed as IBS.The remaining 184 patients met inclusion criteria and agreed to participate.According to the diagnostic criteria of Rome-III constipation,66 patients were diagnosed with constipation,resulting in an incidence rate of 34.2%.There was no significant difference in age,gender,primary disease,dialysis age,dry weight,body mass index and ultrafiltration in hemodialysis patients between constipation and non-constipation groups(P>0.05).There were statistically significant differences in dialysis adequacy between the two groups(P<0.05).There was no significant difference in urea nitrogen,creatinine,hemoglobin,blood calcium,blood phosphorus and other indicators between constipation group and non-constipation group(P>0.05).However,the IS level of the constipation group was higher than that in the non-constipation group,with significant difference(P<0.05).There was no significant difference between the two groups in daily fluid intake(P>0.05).However,in the non-constipation group,the frequency of daily vegetable and fruits intake and exercise was more than that of the constipation group(P<0.05).And the daily vegetable intake in the non-constipation group was more than that in the constipation group(P<0.05).No significant difference was found between the constipation group and the non-constipation group in the use of phosphate binders(P>0.05).TCM Syndrome showed that chronic hemodialysis patients mainly presented as Spleen and Kidney-qi deficiency in the insufficient aspect,and damp-heat syndrome or dampness turbidity syndrome in the excess aspect.The serum level of creatinine in damp-heat syndrome group was significantly higher than that in dampness turbid syndrome group(P<0.05).There was no significant difference in SCr levels between dampness and turbid syndrome group,heat toxin syndrome group and blood stasis syndrome group.The TCM syndromes of constipated hemodialysis patients were mainly intestinal heat syndrome and lung-qi deficiency syndrome,each accounting for 37.9%.No significant difference of serum levels of uremic toxins was found among groups divided by TCM syndromes.After using Dahuang-Huanglian Granule Compund for 4 weeks,patients with intestinal excess-heat syndrome reported that their symptoms of constipation were alleviated,with improved quality of life;their serum creatinine and indoxyl sulfate levels were significantly decreased Conclusion1.The incidence of constipation in hemodialysis patients is higher than that of the general population.2.Chronic hemodialysis patients mainly presented as Spleen and Kidney-qi deficiency in the insufficient aspect,and damp-heat syndrome or dampness turbidity syndrome in the excess aspect.Damp-heat syndrome is strongly correlated to serum creatinine.For those constipated hemodialysis patients,intestinal heat syndrome and lung-qi deficiency syndrome was commonly seen.3.Dahuang-Huanglian Granule Compund can alleviate the symptoms of constipation,improve the quality of life and reduce serum level of creatinine and indoxyl sulfate for constipated patients on hemodialysis. |
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