| Objective:To investigate the risk factors associated with heart failure(HF)in CKD stage 3-5(non-dialysis)patients and the characteristics of their TCM symptoms,hoping to improve current treatment strategies and enhance the recognition of subclinical heart failure at a very early stage,thus breaking the current bottleneck of poor diagnosis and hence insufficient treatment of HF in CKD.Methods:1.Using cross-sectional study,a total of 229 patients with CKD stage 3-5(non-dialysis)who were in-patient treated at the Department of Nephrology,The First Affiliated Hospital of Liaoning University of Chinese Medicine between September 2020 and September 2022 were enrolled according to the nadir criteria.2.Collecting basic patient information,the included patients were divided into non-heart failure group and heart failure group in accordance with the 2018 Chinese Heart Failure Diagnosis and Treatment Guidelines.Clinical information was collected,including patients’ general condition,CKD etiology,heart failure-related risk factors,CKD staging,laboratory indicators,cardiac function classification of patients in the heart failure group,and information on TCM.3.The above data were imported into SPSS software for statistical analysis to compare the above basic information,differences in clinical data and distribution of TCM syndrome between the two groups,to analyse the risk factors for heart failure in patients with chronic kidney disease stage 3-5(non-dialysis)and to explore the distribution of their TCM syndrome.Results:1.In the general analysis,there was no statistical difference in age and gender between the two groups in this study(P > 0.05);in the analysis of primary disease,patients with diabetic nephropathy accounted for a higher proportion in the heart failure group and chronic glomerulonephritis in the non-heart failure group(P < 0.05).In the analysis of common risk factors for heart failure,the number of patients with coronary heart disease and anaemia were higher in the heart failure group than in the non-heart failure group(P < 0.05);in the analysis of laboratory indicators: ALP,i PTH,P,Scr,CRP,24h-Upro were higher in the heart failure group than in the non-heart failure group,and Ca,e GFR,red blood cell count and Hb levels were lower than in the non-heart failure group(P < 0.05).2.CKD stage distribution: 63 patients with CKD stage 3,including 23 patients with secondary CHF(36.5%);90 patients with CKD stage 4,19 patients with secondary CHF(21.1%);76 patients with CKD stage 5,39 patients with secondary CHF(51.3%).the CKD stages were statistically significant between the two groups(p < 0.05).3.Analysis of factors affecting heart failure in patients with CKD stages 3-5: blood i PTH levels,blood P levels,blood CRP levels,24h-Upro levels,and e GFR were positively correlated with the development of heart failure in patients with CKD stages 3-5.Blood Ca levels and blood Hb levels were negatively correlated with the development of heart failure in patients with CKD stage 3-5.4.TCM syndrome distribution in patients with CKD stage 3-5 combined with heart failure:Yang deficiency syndrome was predominant in the heart failure group(P < 0.05),and blood stasis syndrome was predominant in the none-deficiency symptoms(P < 0.05).5.The distribution of cardiac function grading in patients with CKD stage 3-5 combined with heart failure in relation to the distribution of TCM syndromes: among the distribution of deficiency syndromes,Qi deficiency syndromes were the most frequent in cardiac function grade Ⅱ(P < 0.05),with 11 cases(44.0%);among cardiac function grades Ⅲ and Ⅳ,Yang deficiency syndromes were the most frequent(P < 0.05),with 13 cases(48.2%)in cardiac function grade Ⅲ and 18 cases(62.1%)in cardiac function grade Ⅳ.Among the distribution of the none-deficiency symptoms,damp-heat syndrome was the most frequent in patients with Grade II cardiac function,with 12 cases(48.0%);blood stasis syndrome was the most frequent in patients with Grade Ⅲ and Ⅳ cardiac function(P < 0.05),with 10 cases(37.0%)in Grade Ⅲ and 14 cases(48.2%)in Grade Ⅳ.Conclusions:1.The occurrence of heart failure in patients with CKD stages 3-5 was associated with blood i PTH,P,Ca,Hb,CRP,e GFR,and 24h-Upro;with blood i PTH,P,CRP,e GFR,and 24h-Upro positively associated with the occurrence of heart failure.Blood Ca levels and blood Hb levels were negatively correlated with the occurrence of heart failure.2.Distribution of TCM syndrome of heart failure in patients with CKD stage 3-5: Yang deficiency is the predominant syndrome of deficiency,while blood stasis is the predominant syndrome of none-deficiency symptoms.3.Heart function grading and distribution of TCM syndrome in patients with heart failure in CKD stages 3-5: Qi deficiency evidence and Damp-Heat syndrome predominate in heart function grade II;Yang deficiency syndrome and Blood stasis syndrome predominate in heart function grades Ⅲ and Ⅳ. |
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