Yifan Wu

The effect of coix seed on the nutritional status of peritoneal dialysis patients: A pilot study

OBJECTIVE To observe the effect of coix seed diet therapy on the nutritional status of peritoneal dialysis patients and to discuss the potential reasons. METHODS 30 dialysis patients with regular return visit to peritoneal dialysis center of Guangdong Provincial Hospital of Traditional Chinese Medicine were recruited and divided into two groups according to their willingness. 13 patients in control group continued their usual dialysis prescriptions and medications, whereas 30g of coix seed per day was added to the usual therapies of 17 patients in coix seed group. Changes in nutritional status of dialysis patients in two groups were evaluated after a 12-week treatment. RESULTS Two patients (one in each group) quitted the study because of pulmonary infection. After treatment, the nutritional parameters of serum albumin level (P=0.004), total protein level (P=0.008), and body mass index (P=0.023) were increased significantly in coix seed group. And the statistical differences of serum albumin level and body mass index were significantly compared to control group (P=0.008 and P=0.032, respectively). Moreover, the C-reactive protein level had a significant decrease (P=0.001) and the clinical symptoms of dialysis patients including tiredness, anorexia, xerostomia, and abdominal distension showed a significant improvement (P<0.05) in coix seed group. And urinary volume of dialysis patients in coix seed group also had a significant increase (P=0.027). However, there is no significant difference showed in control group. CONCLUSION Coix seed diet therapy plays a role in improving the nutritional status of peritoneal dialysis patients by relieving digestive tract symptoms, increasing urinary volume, and meliorating micro-inflammatory state. But as a pilot study, the results still need to be validated by further large-scale researches.

Ginkgo biloba Extract for Patients with Early Diabetic Nephropathy: A Systematic Review

Objectives. To evaluate the effectiveness and safety of a Ginkgo biloba extract for patients with early diabetic nephropathy. Methods. Randomised controlled trials (RCTs) conducted on adults with early diabetic nephropathy which used Gingko biloba extract were included. The major databases were searched, and manufacturers of Gingko biloba products were contacted for information on any published or unpublished studies. Two authors independently extracted the data from the included studies. Data analysis was conducted using Review Manager 5.0 software. Results. Sixteen RCTs were included. Ginkgo biloba extract decreased the urinary albumin excretion rate (UAER), fasting blood glucose (FBG), serum creatinine (SCR), and blood urea nitrogen (BUN). The extract also improved hemorheology. The methodological quality in the included studies was low. The explicit generation of the allocation sequence was described in only 6 trials. None of the included trials were confirmed to use blinding. Three studies had observed adverse events. One study using angiotensin-converting enzyme inhibitor (ACEi) reported mild cough in both groups. No serious adverse effects were reported. Conclusions. Gingko biloba extract is a valuable drug which has prospect in treating early diabetic nephropathy, especially with high UAER baseline level. The safety for early diabetic nephropathy is uncertain. Long-term, double-blinded RCTs with large sample sizes are still needed to provide stronger evidence.

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.

Telehealth for the management of blood pressure in patients with chronic kidney disease: A systematic Review:

Background Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. Methods Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. Results Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), −5.10; 95% confidence interval (CI), −11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, −4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, −0.38; 95% CI, −0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, −1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, −6.61, 7.81; p > 0.05, p = 0.87) and BP control rate (p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. Conclusions There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.

Good management of chronic kidney disease craves for registration system: A case of a single center in China

Object: to demonstrate the necessity of establishing chronic kidney disease registration system by the case of Guangdong provincial hospital of Chinese medicine. Method: laboratory test results of serum creatinine level and routine urinalysis of all in-hospital patients in year 2012 were collected through the hospitals information system. After excluding repeated test results, estimated glomerular filtration rate (eGFR) of each patient was calculated. Patients with eGFR less than 60ml/min or with abnormal findings on routine urinalysis were included. Prevalence of chronic kidney disease (CKD) was investigated. Besides, number of CKD patients admitted to nephrology department was compared with those who were admitted to other departments. Results: there were 58683 cases of hospitalized patients who took the test of serum creatinine level and urinalysis in the year 2012. 20941 cases were diagnosed as CKD. Prevalence of CKD in Guangdong provincial hospital of Chinese medicine was 35.7%. The proportion of CKD patients receiving medical treatment in nephrology department was 22.2%. It occupied 11.4%, 13.2%, 16.8%, 66.0% and 90.8% of the total amount of CKD population of each stage from stage one to five respectively. Among other departments, top five departments with the largest number of CKD patients were emergency, breast, cardiovascular, urology and general departments. Conclusions: prevalence of CKD in Guangdong provincial hospital of Chinese medicine was high while the ratio of patients receiving nephrology specialized treatment was extremely low. This situation was contrary to the recommendation of early specialist intervention in CKD population. In order to achieve better management and improve prognosis, chronic kidney disease registration system was in great need.

Management of Chronic Kidney Disease in China Calls for The Implementation of Expert Patient Program with Traditional Chinese Medical Interventions

Chronic kidney disease was closely related with unhealthy lifestyle; therefore a strategy focused both on daily life and medical process, like the Expert Patients Program, was of great value in the prevention and treatment of chronic kidney disease. In China, however, obstacles still existed in the process of implementing the program. Adding traditional Chinese medical interventions to the program assisted both patients and physicians to understand and to accept this new trend in management of chronic disease better. The combination with traditional Chinese medical interventions showed a solution for successfully implementing the Expert Patients Program and provided a new strategy for prevention and control of chronic kidney disease.

Analyzing the relationship between traditional Chinese medicine patterns and biochemical parameters in CKD population based on informations sharing system

Object: to analyze the relationship between traditional Chinese medicine (TCM) patterns and biochemical parameters in chronic kidney disease (CKD) population; and to discuss the practicality and application of the Informations Sharing System. Method: clinical informations and laboratory tests results of CKD population were input into the system. Diagnosis of TCM patterns and laboratory tests results of eligible cases were output via the system by ETL tool. Selected data were analyzed using SPSS. Results: 1) all CKD patients were diagnosed as deficiency-excess complex pattern. In the component of deficiency pattern, 80.2% (267 cases) was spleen-kidney qi deficiency, 7.5% (25 cases) was spleen-kidney yang deficiency and 12.3% (41 cases) was dual deficiency of qi and yin. As to the component of excess pattern, 51.4% (171 cases) was dampness-heat with blood stasis, 45% (150 cases) was dampness turbidity with blood stasis and 3.6% (12 cases) was blood stasis; 2) in comparison between different types of deficiency patterns, there were significant differences in biochemical results, including PT, APTT, ALB, Ca and GLU. Laboratory results of PT, APTT, ALB, HGB, HCT also showed statistic differences among various excess patterns. Conclusion: The TCM patterns correlated with western pathology in CKD population, which provided objective references of TCM patterns diagnosis. This study revealed the integrated function of clinic and research in the Information Sharing System and showed the design method for similar medical data system.