Dr Xu Daji shares the clinical study findings on Chinese medicine treatment of chronic renal failure


徐大基博士分享中醫藥治療慢性腎衰的臨床觀察結果

Traditional Chinese medicine for the treatment of chronic renal failure


常用於治療慢性腎衰的中藥

Date: 06 Jun 2017 (Tuesday)

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HKBU clinical study finds effective stability rate of over 80% in Chinese medicine treatment of chronic renal failure

浸大臨床觀察顯示中醫藥治療慢性腎衰有效穩定率逾八成

The School of Chinese Medicine (SCM) recently conducted a clinical study on Chinese medicine treatment of chronic renal failure. The findings indicated that the effective stability rate of the Chinese medicine treatment for this disease for periods of three months, half a year and one year is 96.3%, 88.89% and 83.95% respectively.

The incidence of chronic kidney disease has recently been found to be in an upward trend in the world. The number of people suffering from the disease amounts to approximately 10% of the overall population in adults. If a patient with chronic kidney disease does not receive appropriate treatment, a severe condition such as chronic renal failure may follow.
   
Chronic renal failure is a progressive illness for which no obvious symptoms may be observed in its early stage. At a more severe stage of the disease, patients may suffer symptoms such as fatigue, weakness, edema, nausea, retching and itchiness. They will develop various complications, such as heart failure, hyperkalemia and gastrointestinal bleeding, when the kidney function deteriorates. At the final stage of renal failure,patients are required to receive treatments such as heamodialysis, peritoneal dialysis or kidney transplant.

Dr Xu Daji, Senior Lecturer of the SCM Clinical Division, conducted a clinical observation of 162 patients who attended HKBU’s Chinese medicine clinics for treatment of chronic renal failure from May 2008 to December 2016. The 90 male and 72 female patients, with ages ranging from 18 to 86, had been suffering from the disease for periods ranging from three months to 26 years. According to the preset criteria, all patients were in the diagnosis stage of one to three – that is a glomerular filtration rate below 80ml/min. Also, they had not received treatments of heamodialysis and peritoneal dialysis.

Based on the principle of syndrome differentiation and treatment in traditional Chinese medicine (TCM), Dr Xu classified the patients into several groups according to their different types of TCM syndromes. Of them, 43 patients (26.54%) belonged to the type of “spleen and kidney deficiency, wet poison and blood stasis resistance”; 30 patients (18.52%) were in the group of “spleen and kidney deficiency, deficiency of qi and blood”; 22 (13.58%) were diagnosed as “trapped spleen dampness”, while the remaining 67 patients belonged to other syndrome types. Dr Xu explained that the pathogenesis of chronic renal failure mainly arises from spleen and kidney deficiency, wet poison and blood stasis resistance. In view of this, the corresponding Chinese medicine treatment for this disease focused on invigorating the spleen and kidney, while also supplementing qi and nourishing blood and reducing dampness and turbidity.
 
Dr Xu considered that the syndrome differentiation and treatment in TCM helps to improve the clinical syndromes of the patients and provides obvious efficacy in treating related complications. The study results showed that the effective stability rate of the Chinese medicine treatment for patients suffering from the disease in the early diagnosis stage for a year was 90.23% whereas for those suffering for a year in the diagnosis stage of three, the rate was 70.47%. This indicated that the earlier a patient receives the Chinese medicine treatment for chronic renal failure, the better the clinical effect will be.

The study also conducted an analysis on patients’ awareness of the disease, and found that the majority of patients knew they were suffering from the disease while some of them learned about their health conditions from physical examinations. Individual cases did not realise they were at the final stage of renal failure. This indicated the importance of enhancing public education about chronic kidney diseases.

During the clinical observation, some patients were found to have an infection, which worsened their health conditions. A total of 29.89% cases were found to have an infection in their respiratory tract, urinary tract, gastrointestinal area, skin, and so forth. The primary causes of diabetes, high blood pressure and chronic nephritis, were commonly observed in patients, amounting to 69.75% of the cases. This provided a strong illustration that the prevention of these primary causes of illness in their early stage and maintaining a healthy body condition were effective measures in preventing chronic renal failure from getting worse. Dr Xu explained that an unhealthy diet, intense fatigue, staying up late and insomnia were among the reasons leading to the deterioration of chronic renal failure. He encouraged people to take good care of their daily health and maintain a healthy lifestyle as well as avoid abusing medicines that are harmful to the kidney, such as pain-killers.

中醫藥學院最近完成一項有關中醫藥治療慢性腎衰的臨床觀察,結果顯示中醫藥治療相關病患達3個月的有效穩定率為96.3%,治療達半年的有效穩定率為88.89%,治療1年的有效穩定率則為83.95%。

現時全球慢性腎臟病發病率正不斷上升,患病人數約佔成年人口的百分之十。若慢性腎臟病患者沒有得到妥善合適的治療,或有機會令病情惡化而演變成慢性腎衰。慢性腎衰是一種進展性疾病,患者早期可能沒有特殊症狀,但病情進一步加劇時,則有可能出現倦怠、乏力、水腫、噁心、嘔吐、皮膚瘙癢等症狀。當患者腎功能嚴重惡化時,更會出現各種併發症,如心衰、高血鉀、消化道出血等。晚期的腎衰患者需要進行血液透析、腹膜透析或腎移植等治療。

負責有關臨床研究的中醫藥學院臨床部高級講師徐大基博士早前分析了162名於2008年5月至2016年12月期間,前往浸大中醫藥診所求診的慢性腎衰患者病例,男女分別佔90例和72例,年齡介乎18至86歲,患病期由3個月至26年不等。所有患者均符合慢性腎衰的診斷標準,屬於慢性腎衰1至3期,即腎小球濾過率小於80ml/min;同時並未曾進行腹膜透析、血液透析等治療。

根據中醫辨證論治原則,徐大基博士將臨床觀察的慢性腎衰患者歸納為不同的中醫證型,當中43例 (26.54%) 為脾腎虧虛及濕毒瘀阻型、30例 (18.52%) 為脾腎氣血虧虛型,另外22例 (13.58%) 為濕濁困脾型,其餘67例為其他中醫證型。徐博士解釋,慢性腎衰的主要病機是脾腎虧虛、氣血不足、濕毒瘀阻,因此中醫治療相關病患的重點在於健脾補腎、益氣養血和化濕降濁。

徐博士認為,中醫辨證治療有助於改善患者的臨床症狀,對治療併發症或合併症等方面有顯著成效。是次臨床觀察結果顯示,中醫藥治療有1年病歷的早期病患者的有效穩定率達90.32%,而對1年病歷的第3期患者,有效治療穩定率則為70.47%,顯示患者愈早進行中醫藥治療,臨床效果愈佳。

另一方面,臨床觀察並分析了患者對慢性腎衰的認知度,大多數患者均知道自己腎衰的情況;部分患者是從體檢中得知,有個別患者並不清楚自己已處於腎衰晚期,這反映加強社會大眾對慢性腎衰知識和教育的重要性。

在觀察的病例中,部分患者病情加重的原因主要是感染,包括呼吸道感染、尿路感染、胃腸炎及皮膚感染等,合共佔29.89%;原發病因為糖尿病、高血壓、慢性腎炎等非常多見,合共佔69.75%,說明加強這些基礎病的早期防治,提升體質以防感染,是預防慢性腎衰惡化的有效措施。徐大基博士表示,飲食不當、過度勞累、熬夜、失眠等亦是加重慢性腎衰的原因之一,因此大家應注意日常生活調養和改善生活方式,另外亦應避免濫用對腎有損害性的藥物,如止痛藥等。