Chuan Zou

Colon may provide new therapeutic targets for treatment of chronic kidney disease with Chinese medicine

Chronic kidney disease (CKD) has become a worldwide health and social problem. Retarding its progression to end-stage renal disease is beneficial both to the patients and the healthcare system. Plenty of clinical trials have indicated that enema with Chinese medicine could effectively prevent chronic renal failure, and was widely used in the clinical practice. However, studies on mechanism were still nearly blank, which may prevent further improvement of therapeutic efficacy. Recent studies had discovered that colon was an important organ where uremic toxins were generated. The uremic toxins involved could not only promote CKD progression, but also was closely correlated with CKD mortality. Reducing production and promoting excretion of toxins were confirmed to reduce renal tubule interstitial fibrosis and delay renal progression. On the basis of the theory of gut-kidney axis above, we had conducted pilot clinical researches to evaluate the effect of enema with Chinese medicine on the intestinal flora, gut barrier, enterogenous uremic toxins and renal protection. The preliminary results revealed that rheum enema through colon could accelerate intestinal dynamics, improve intestinal barrier function, regulate intestinal flora and reduce production and absorption of intestine-derived uremic toxins such as indoxyl sulfate, which may reduce renal fibrosis and delay renal progression. Further studies could provide more evidence for colon as a new therapeutic target for the treatment of CKD with Chinese medicine.

Auricular Acupressure on Specific Points for Hemodialysis Patients with Insomnia: A Pilot Randomized Controlled Trial

Objectives To assess the feasibility and acceptability of a randomized controlled trial compared auricular acupressure (AA) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis (MHD) patients with insomnia. Methods Sixty three (63) eligible subjects were randomly assigned into either AA group received AA on specific acupoints (n=32), or sham AA (SAA) group received AA on points irrelevant to insomnia treatment (n=31) for eight weeks. All participants were followed up for 12 weeks after treatments. The primary outcome was clinical response at eight weeks after randomization, defined as a reduction of Pittsburgh Sleep Quality Index (PSQI) global score by 3 points and more. Results Fifty-eight (58) participants completed the trial and five dropped out. Twenty participants in AA group (62.5%) and ten in SAA group (32.3%) responded to the eight-week interventions (χ2 = 5.77, P = 0.02). PSQI global score declined 3.75 ± 4.36 (95%CI -5.32, -2.18) and 2.26 ± 3.89 (95%CI -3.68, -0.83) in AA group and SAA group respectively. Three participants died during the follow-up period. No evidence supported their deaths were related to the AA intervention. No other adverse event was observed. Conclusion Feasibility and logistics of patient recruitment, randomization procedure, blinding approach, interventions application and outcome assessment had been tested in this pilot trial. The preliminary data appeared to show a favorable result on AA treatment. A full-scale trial is warranted. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272.

Chinese herbal medicine Danshen formulations for preventing renal disease in Henoch-Schönlein Purpura: a systematic review and meta-analysis.

OBJECTIVES The study objective was to evaluate the use of Danshen formulations in preventing renal disease in Henoch-Schönlein Purpura (HSP) either as sole agents or in combination with other drug regimens. METHODS Search strategy--Databases searched were the Cochrane Central Register of Controlled Trials, PubMed, Embase (Excerpta Medica Database), the Chinese Biomedicine Database, CNKI (Chinese National Knowledge Infrastructure), and VIP-database for all relevant studies without any language restriction. The cut-off date for the search was October 2010. Selection criteria--All randomized controlled trials with enrolled patients of all ages without renal disease before random assignment were included. The primary outcomes were the number of patients who developed renal disease and the incidence of adverse effects of drugs. Data collection and analysis--For dichotomous outcomes, the incidence of renal disease in patients with HSP was calculated as a relative risk with 95% confidence intervals. For continuous outcomes, the weighted mean difference with 95% confidence intervals was used. RESULTS A total of five trials (513 children aged 2-14 years old) were included in the meta-analyses, which indicated that Danshen formulations (injections or tablets) with symptomatic therapy significantly reduced the risk of developing renal disease in children with HSP compared to symptomatic therapy alone 6-12 months after treatment (relative risk: 0.35, 95% confidence interval: 0.20-0.61). Adverse effects of Danshen formulations were not explicitly reported in these studies. CONCLUSIONS Danshen formulations may help prevent renal disease in children with HSP without serious side-effects. However, the evidence is of low quality (as assessed using the GRADE approach), and thus there is insufficient proof to strongly recommend the use of Danshen formulations in children with HSP. Large, properly randomized, placebo-controlled, double-blind studies are needed to substantiate its use.

Chinese Medicinal Herbs for Childhood Pneumonia: A Systematic Review of Effectiveness and Safety

Objective. To assess the efficacy and safety of Chinese medicinal herbs for Childhood Pneumonia. Methods. We included randomized controlled trials (RCTs). The searched electronic databases included PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, CBM, CNKI, and VIP. All studies included were assessed for quality and risk bias. Review Manager 5.1.6 software was used for data analyses, and the GRADEprofiler software was applied to classify the systematic review results. Results. Fourteen studies were identified (n = 1.824). Chinese herbs may increase total effective rate (risk ratio (RR) 1.18; 95% confidence interval (CI), 1.11–1.26) and improve cough (total mean difference (MD), −2.18; 95% CI, (−2.66)–(−1.71)), fever (total MD, −1.85; 95% CI, (−2.29)–(−1.40)), rales (total MD, −1.53; 95% CI, (−1.84)–(−1.23)), and chest films (total MD, −3.10; 95% CI, (−4.11)–(−2.08)) in Childhood Pneumonia. Chinese herbs may shorten the length of hospital stay (total MD, −3.00; 95% CI, (−3.52)–(−2.48)), but no significant difference for adverse effects (RR, 0.39; 95% CI, 0.09–1.72) was identified. Conclusion. Chinese herbs may increase total effective rate and improve symptoms and signs. However, large, properly randomized, placebo-controlled, double-blind studies are required.

Astragalus in the Prevention of Upper Respiratory Tract Infection in Children with Nephrotic Syndrome: Evidence-Based Clinical Practice

Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012), PUBMED (1966–2012.8), CBM (1978–2012.8), VIP (1989–2012.8), and CNKI (1979–2012.8), were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33–0.93). The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus) twice per day, at least for 3–6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome.

The study of the constitution, mucosal inflammation, Chinese medicine syndrome types and clinical pathology in IgA nephropathy

Objective: This study is to investigate the constitution, mucosal inflammation, Chinese medicine syndrome types, clinical and pathological characteristics of patients with IgA nephropathy (IgA N)and to analysis their relationships in order to provide the scientfic basis and new ideas for the management of IgAN. Methods: Through the cross sectional and retrospective study, we investigated 262 patients with IgAN in the Hospital of Guangdong provincical TCM hospital and the Third Hospital of Peking Universitiy between January 2011 and January 2014. We collected the Chinese medicine syndrome types, clinical and pathological data, the constitution questionnaire and the mucosal inflammation. Results: The constitution of yin-yang harmony was the most common(40.5%), followed by qideficiency(31.3%). Upper respiratory infection, chronic periodontitis, scytitis were very common in patients with IgAN. Qi deficiency of spleen and kidney were the common type: 69.1%. Asymptomatic abnormal urinalysis(50.4% of the patients)and CKD 1(48.5%)were the most common clinical Presentation. HaasD was the most common pathological presentation(47.3%). Patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony presented with more nonmucosal inflammation, more CKD3-4, higher than the latter in the level of serum creatinine, urea nitrogen, serum CH50 and lower in GFR clinically as compared to those patients with the constitution of qi deficiency. Conclusions: IgAN onsets silently and asymptomatic abnormal urinalysis was the most common clinical type. Frequent upper respiratory infection, chronic periodontitis and recurrent scytitis were common in patients with IgAN. IgAN patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony had higher serum CH50 level, low incidence of mucosal inflammation, increased risk of declined renal function and more sever renal pathlogical changes than that of patients with qi deficiency of spleen and kidney and the constitution of qi deficiency.

Auricular acupressure for insomnia in hemodialysis patients: study protocol for a randomized controlled trial

BackgroundPatients on maintenance hemodialysis (MHD) frequently complain of insomnia. Poor sleep quality impairs their quality of life and adversely affects long-term outcome. Previously we applied auricular acupressure therapy (AAT) for MHD patients with insomnia and yielded favorable results. AAT probably improves sleep quality by stimulating the vagus nerve and inhibiting sympathetic overactivity. However, the efficacy of AAT for insomnia in this population is still lacking. The proposed randomized controlled trial (RCT) will evaluate the efficacy and safety of AAT for improvement of sleep quality in MHD patients with insomnia.Methods/designThe proposed study is a multi-center, double-blind (participants and assessors), parallel-group RCT. A total of 112 participants with insomnia will be recruited from six hemodialysis centers in Guangzhou, China, and randomly allocated in a 1:1 ratio to receive auricular acupressure on either active points (AA group) or control points (points irrelevant to insomnia management, SAA group). The treatment will last for 8 weeks prior to a follow-up period of 12 weeks. Evaluation by blinded assessors at baseline, at 8 weeks (end of treatment) as well as at 4-week, 8-week and 12-week follow-ups (after intervention) will include Pittsburgh Sleep Quality Index (PSQI) scores and average weekly dose of hypnotics. The primary endpoint is clinical response rate (percentage of participants who reach a reduction of PSQI global score ≥ 3 in each group) at 8 weeks from baseline. Secondary endpoints include the changes in PSQI scores over time from baseline, as well as the changes in weekly dose of hypnotics.DiscussionThis paper describes the rationale and design of a double-blind RCT that aims to determine the efficacy and safety of AAT for insomnia of hemodialysis patients. If successful, this project will provide evidence of the efficacy and safety of AAT for insomnia of hemodialysis patients.Trial registrationClinicalTrials.gov, Identifier: NCT03015766. Registered on 22 December 2016.

Syndrome Differentiation of IgA Nephropathy Based on Clinicopathological Parameters: A Decision Tree Model.

Background. IgA nephropathy is the most common cause of primary glomerulonephritis in China, and Traditional Chinese Medicine (TCM) is a vital treatment strategy. However, not all doctors prescribing TCM medicine have adequate knowledge to classify the syndrome accurately. Aim. To explore the feasibility of differentiation of TCM syndrome types among IgA nephropathy patients based on clinicopathological parameters. Materials and Methods. The cross-sectional study enrolled 464 biopsy-proven IgA nephropathy adult patients from 2010 to 2016. The demographic data, clinicopathological features, and TCM syndrome types were collected, and the decision tree models based on classification and regression tree were built to differentiate between the syndrome types. Results. 370 patients of training dataset were 32 years old with serum creatinine of 79 μmol/L, estimated glomerular filtration rate (eGFR) of 97.2 mL/min/1.73 m2, and proteinuria of 1.0 g/day. The scores of Oxford classifications were as follows: M1 = 97.6%, E1 = 14.6%, S1 = 50.0%, and T1 = 52.2%/T2 = 18.4%. The decision trees without or with MEST scores achieved equal precision in training data. However, the tree with MEST scores performed better in validation dataset, especially in classifying the syndrome of qi deficiency of spleen and kidney. Conclusion. A feasible method to deduce TCM syndromes of IgA nephropathy patients by common parameters in routine clinical practice was proposed. The MEST scores helped in the differentiation of TCM syndromes with clinical data.