Traditional Chinese Medicine related factors of planned dialysis in chronic kidney disease stage 5 patients with type 2 diabetes mellitus: a multicenter cross-sectional study

doi:10.19852/j.cnki.jtcm.2026.04.018

Journal of Traditional Chinese Medicine ›› 2026, Vol. 46 ›› Issue (4): 982-989.DOI: 10.19852/j.cnki.jtcm.2026.04.018

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Traditional Chinese Medicine related factors of planned dialysis in chronic kidney disease stage 5 patients with type 2 diabetes mellitus: a multicenter cross-sectional study

ZHANG Ruimin¹^,², LI Shuang³, QU Yilun³, WANG Qian³, XIE Huidi³, WANG Xiaolong³, DUAN Shuwei³, WU Jie³, WANG Yong³, DONG Zheyi³(), CHEN Xiangmei¹^,²()

¹ School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
² Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for the Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Beijing 100853, China
³ Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for the Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Beijing 100853, China

Received:2025-06-03 Accepted:2025-10-27 Online:2026-08-15 Published:2026-08-08
Contact: Prof. CHEN Xiangmei, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for the Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Beijing 100853, China. xmchen301@126.com;
Prof. DONG Zheyi, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for the Prevention and Treatment of Pan-vascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310), Beijing 100853, China. shengdai26@163.com,Telephone: +86-10-66935462
Supported by:
Capital’s Funds for Health Improvement and Research: Research on Intelligent Prevention and Control System and Strategy for the Whole Disease Cycle of Diabetic Nephropathy(CFH 2024-1-5021);Beijing Science and Technology Plan Project: Study on Multidimensional Precise Diagnosis and Treatment Technology and Clinical Transformation of Type 2 Diabetic Nephropathy(Z221100007422121);Collaborative Research Project of Traditional Chinese and Western Medicine for Major and Difficult Diseases in Beijing: Chronic Renal Failure and its Complications Collaborative Research Project of Traditional Chinese and Western Medicine(2023BJSZDYNJBXTGG-001-01)

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Abstract

Abstract:

OBJECTIVE: To clarify the distribution of Traditional Chinese Medicine (TCM) symptoms, syndrome elements and complications in chronic kidney disease stage 5 (CKD5) patients with type 2 diabetes mellitus (T2DM), and to analyze the correlation factors between dialysis and non-dialysis patients, so as to provide reference for clinical syndrome differentiation and treatment.

METHODS: The general information, laboratory indicators, and TCM syndrome factors of CKD5 patients with T2DM were obtained upon admission. The participants were divided into non-dialysis and dialysis groups according to the treatment methods used. Multivariate logistic regression was used for analysis. The probability of planned dialysis in CKD5 patients with T2DM was calculated by combining multiple TCM syndrome factors, and a receiver operating characteristic curve was drawn.

RESULTS: Approximately 77.2% of the study participants were men, with a median age of 59 years. A total of 277 and 95 patients comprised the non-dialysis and dialysis groups, respectively. The median duration of dialysis was 49.6 d. The dialysis group had a significantly higher serum creatinine level; a significantly lower estimated glomerular filtration rate, serum uric acid level, and 24-h urinary protein level; and a significantly lower proportion of patients with atherosclerosis (P < 0.01). The frequencies of Water stagnation pattern, Damp retention pattern, Heart deficiency pattern, and Lung deficiency pattern in the dialysis group were significantly higher (P < 0.01，P < 0.05), while the frequencies of Phlegm turbidity pattern and Kidney deficiency pattern were significantly lower (P < 0.01). Male sex [odds ratio (OR) = 1.780], Heart deficiency pattern (OR = 3.714), Yindeficiency pattern (OR = 2.262), and Water stagnation pattern (OR = 1.984) were factors related to planned dialysis in CKD5 patients with T2DM. The area under the receiver operating characteristic curve for planned dialysis in CKD5 patients with T2DM was 73.8% [95% confidence interval (0.680, 0.797), P < 0.001].

CONCLUSIONS: Male sex, Heart deficiency pattern, Yindeficiency pattern, and Water stagnation pattern were correlated with planned dialysis in CKD5 patients with T2DM. Kidney deficiency pattern and Phlegm turbidity pattern were correlated with CKD5 patients with T2DM who had not yet started planned dialysis. The study of TCM syndrome elements provides therapeutic ideas for relieving the uncomfortable symptoms of CKD 5 patients with T2DM, and provides reference for clinical syndrome differentiation and treatment.

Key words: diabetes mellitus, type 2, chronic kidney disease stage 5, planned dialysis, syndrome complex, multicenter study, cross-sectional studies

ZHANG Ruimin, LI Shuang, QU Yilun, WANG Qian, XIE Huidi, WANG Xiaolong, DUAN Shuwei, WU Jie, WANG Yong, DONG Zheyi, CHEN Xiangmei. Traditional Chinese Medicine related factors of planned dialysis in chronic kidney disease stage 5 patients with type 2 diabetes mellitus: a multicenter cross-sectional study[J]. Journal of Traditional Chinese Medicine, 2026, 46(4): 982-989.

Figures/Tables 4

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Index	Total (n = 372)	Non-dialysis group (n = 277)	Dialysis group (n = 95)	t/Z/χ ² value	P value
Male [n (%)]^a	287 (77.2)	221 (79.8)	66 (69.5)	4.265	0.039
Age (years)	59.00 (51.00, 66.00)	59.00 (51.00, 66.00)	61.00 (52.00, 68.50)	－0.979	0.328
BMI (kg/m²)	25.62 (23.50, 28.30)	25.70 (23.60, 28.10)	25.30 (23.27, 28.45)	－0.619	0.536
SBP (mm Hg)	155±23	154±23	156±22	－0.638	0.524
DBP (mm Hg)	81.00 (74.00, 90.00)	81.00 (74.00, 90.00)	80.00 (72.50, 90.00)	－1.031	0.311
TC (mmol/L)	4.15 (3.24, 5.22)	4.18 (3.26, 5.36)	3.87 (3.17, 4.75)	－1.549	0.121
TG (mmol/L)	1.59 (1.14, 2.40)	1.65 (1.13, 2.48)	1.48 (1.18, 2.07)	－1.208	0.227
LDL-C (mmol/L)	2.41 (1.74, 3.35)	2.50 (1.78, 3.39)	2.25 (1.57, 3.18)	－1.849	0.064
Diabetes course (months)	180.00 (111.75, 240.00)	168.00 (108.00, 240.00)	180.00 (120.00, 240.00)	－0.518	0.605
GHb (%)	6.20 (5.40, 7.00)	6.30 (5.40, 7.00)	6.00 (5.50, 6.85)	－0.563	0.573
eGFR [mL·(min/1.73 m²)^-1]^b	8.81 (6.17, 11.41)	9.55 (6.93, 12.08)	5.82 (4.47, 8.46)	－7.371	<0.001
Hb (g/L)	95±18	95±17	93±20	1.160	0.247
Alb (g/L)	34±6	34±6	34±6	－0.558	0.577
24-h urine protein quantification (g)^b	4.54 (2.37, 6.44)	4.65 (2.46, 6.91)	3.77 (2.08, 4.73)	－3.231	0.001
24-h urine volume (L)^b	1.96 (1.45, 2.40)	2.00 (1.53, 2.50)	1.70 (0.90, 1.96)	－5.230	<0.001
24-h urine protein concentration (g/L)	2.44 (1.72, 3.11)	2.44 (1.60, 3.23)	2.44 (2.01, 2.75)	－0.439	0.661
Scr (μmol/L)^b	475.80 (376.28, 637.33)	436.30 (361.20, 550.90)	663.10 (502.45, 860.85)	－8.232	<0.001
BUN (mmol/L)	20.69 (16.61, 27.07)	20.27 (16.60, 26.14)	21.66 (16.65, 30.14)	－1.340	0.180
UA (μmol/L)^b	420±116	430±112	394±124	2.609	0.009
Hypertension [n (%)]	283 (76.1)	207 (74.7)	76 (80.0)	1.080	0.299
Hyperuricemia [n (%)]	207 (55.6)	161 (58.1)	46 (48.4)	2.698	0.100
Hyperlipidemia [n (%)]	370 (99.5)	276 (99.6)	94 (98.9)	-	0.446
Coronary heart disease [n (%)]	103 (27.7)	77 (27.8)	26 (27.4)	0.007	0.936
Atherosclerosis [n (%)] ^b	217 (58.3)	173 (62.5)	44 (46.3)	7.581	0.006
Fatty liver [n (%)]	44 (11.8)	36 (13.0)	8 (8.4)	1.420	0.233

Index	Total (n = 372)	Non-dialysis group (n = 277)	Dialysis group (n = 95)	t/Z/χ ² value	P value
Male [n (%)]^a	287 (77.2)	221 (79.8)	66 (69.5)	4.265	0.039
Age (years)	59.00 (51.00, 66.00)	59.00 (51.00, 66.00)	61.00 (52.00, 68.50)	－0.979	0.328
BMI (kg/m²)	25.62 (23.50, 28.30)	25.70 (23.60, 28.10)	25.30 (23.27, 28.45)	－0.619	0.536
SBP (mm Hg)	155±23	154±23	156±22	－0.638	0.524
DBP (mm Hg)	81.00 (74.00, 90.00)	81.00 (74.00, 90.00)	80.00 (72.50, 90.00)	－1.031	0.311
TC (mmol/L)	4.15 (3.24, 5.22)	4.18 (3.26, 5.36)	3.87 (3.17, 4.75)	－1.549	0.121
TG (mmol/L)	1.59 (1.14, 2.40)	1.65 (1.13, 2.48)	1.48 (1.18, 2.07)	－1.208	0.227
LDL-C (mmol/L)	2.41 (1.74, 3.35)	2.50 (1.78, 3.39)	2.25 (1.57, 3.18)	－1.849	0.064
Diabetes course (months)	180.00 (111.75, 240.00)	168.00 (108.00, 240.00)	180.00 (120.00, 240.00)	－0.518	0.605
GHb (%)	6.20 (5.40, 7.00)	6.30 (5.40, 7.00)	6.00 (5.50, 6.85)	－0.563	0.573
eGFR [mL·(min/1.73 m²)^-1]^b	8.81 (6.17, 11.41)	9.55 (6.93, 12.08)	5.82 (4.47, 8.46)	－7.371	<0.001
Hb (g/L)	95±18	95±17	93±20	1.160	0.247
Alb (g/L)	34±6	34±6	34±6	－0.558	0.577
24-h urine protein quantification (g)^b	4.54 (2.37, 6.44)	4.65 (2.46, 6.91)	3.77 (2.08, 4.73)	－3.231	0.001
24-h urine volume (L)^b	1.96 (1.45, 2.40)	2.00 (1.53, 2.50)	1.70 (0.90, 1.96)	－5.230	<0.001
24-h urine protein concentration (g/L)	2.44 (1.72, 3.11)	2.44 (1.60, 3.23)	2.44 (2.01, 2.75)	－0.439	0.661
Scr (μmol/L)^b	475.80 (376.28, 637.33)	436.30 (361.20, 550.90)	663.10 (502.45, 860.85)	－8.232	<0.001
BUN (mmol/L)	20.69 (16.61, 27.07)	20.27 (16.60, 26.14)	21.66 (16.65, 30.14)	－1.340	0.180
UA (μmol/L)^b	420±116	430±112	394±124	2.609	0.009
Hypertension [n (%)]	283 (76.1)	207 (74.7)	76 (80.0)	1.080	0.299
Hyperuricemia [n (%)]	207 (55.6)	161 (58.1)	46 (48.4)	2.698	0.100
Hyperlipidemia [n (%)]	370 (99.5)	276 (99.6)	94 (98.9)	-	0.446
Coronary heart disease [n (%)]	103 (27.7)	77 (27.8)	26 (27.4)	0.007	0.936
Atherosclerosis [n (%)] ^b	217 (58.3)	173 (62.5)	44 (46.3)	7.581	0.006
Fatty liver [n (%)]	44 (11.8)	36 (13.0)	8 (8.4)	1.420	0.233

TCM syndrome element	Total (n = 372)	Non-dialysis group (n = 277)	Dialysis group (n = 95)	χ ² value	P value
Qi deficiency pattern	275 (73.9)	202 (72.9)	73 (76.8)	0.563	0.453
Blood deficiency pattern	245 (65.9)	184 (66.4)	61 (64.2)	0.154	0.694
Yin deficiency pattern	217 (58.3)	154 (55.6)	63 (66.3)	3.345	0.067
Yang deficiency pattern	216 (58.1)	155 (56.0)	61 (64.2)	1.979	0.159
Heat pattern	138 (37.1)	98 (35.4)	40 (42.1)	1.371	0.242
Qi stagnation pattern	194 (52.2)	144 (52.0)	50 (52.6)	0.012	0.913
Water stagnation pattern^a	142 (38.2)	94 (33.9)	48 (50.5)	8.251	0.004
Damp retention pattern^a	220 (59.1)	155 (56.0)	65 (68.4)	4.548	0.033
Blood stasis pattern	347 (93.3)	256 (92.4)	91 (96.8)	1.282	0.258
Phlegm turbidity pattern^a	139 (37.4)	117 (42.2)	22 (23.2)	11.004	0.001
Heart deficiency pattern^a	309 (83.1)	220 (79.4)	89 (93.7)	10.228	0.001
Liver deficiency pattern	347 (93.3)	260 (93.9)	87 (91.6)	0.589	0.443
Spleen deficiency pattern	200 (53.8)	145 (52.3)	55 (57.9)	0.876	0.349
Lung deficiency pattern^a	210 (56.5)	145 (52.3)	65 (68.4)	7.435	0.006
Kidney deficiency pattern^a	350 (94.1)	267 (96.4)	83 (87.4)	10.347	0.001

TCM syndrome element	Total (n = 372)	Non-dialysis group (n = 277)	Dialysis group (n = 95)	χ ² value	P value
Qi deficiency pattern	275 (73.9)	202 (72.9)	73 (76.8)	0.563	0.453
Blood deficiency pattern	245 (65.9)	184 (66.4)	61 (64.2)	0.154	0.694
Yin deficiency pattern	217 (58.3)	154 (55.6)	63 (66.3)	3.345	0.067
Yang deficiency pattern	216 (58.1)	155 (56.0)	61 (64.2)	1.979	0.159
Heat pattern	138 (37.1)	98 (35.4)	40 (42.1)	1.371	0.242
Qi stagnation pattern	194 (52.2)	144 (52.0)	50 (52.6)	0.012	0.913
Water stagnation pattern^a	142 (38.2)	94 (33.9)	48 (50.5)	8.251	0.004
Damp retention pattern^a	220 (59.1)	155 (56.0)	65 (68.4)	4.548	0.033
Blood stasis pattern	347 (93.3)	256 (92.4)	91 (96.8)	1.282	0.258
Phlegm turbidity pattern^a	139 (37.4)	117 (42.2)	22 (23.2)	11.004	0.001
Heart deficiency pattern^a	309 (83.1)	220 (79.4)	89 (93.7)	10.228	0.001
Liver deficiency pattern	347 (93.3)	260 (93.9)	87 (91.6)	0.589	0.443
Spleen deficiency pattern	200 (53.8)	145 (52.3)	55 (57.9)	0.876	0.349
Lung deficiency pattern^a	210 (56.5)	145 (52.3)	65 (68.4)	7.435	0.006
Kidney deficiency pattern^a	350 (94.1)	267 (96.4)	83 (87.4)	10.347	0.001

Variable	B	SE	Wald	df	P value	Exp (B)	95% CI
Variable	B	SE	Wald	df	P value	Exp (B)	Lower	Upper
Gender (male)	0.577	0.289	3.986	1	0.046	1.780	1.011	3.137
Yin deficiency pattern	0.816	0.281	8.439	1	0.004	2.262	1.304	3.923
Water stagnation pattern	0.685	0.259	6.984	1	0.008	1.984	1.194	3.299
Phlegm turbidity pattern	－1.125	0.290	15.084	1	<0.001	0.325	0.184	0.573
Heart deficiency pattern	1.312	0.468	7.845	1	0.005	3.714	1.483	9.304
Kidney deficiency pattern	－1.589	0.486	10.701	1	0.001	0.204	0.079	0.529
Constant	－1.320	0.638	4.280	1	0.039	0.267	-	-

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Traditional Chinese Medicine related factors of planned dialysis in chronic kidney disease stage 5 patients with type 2 diabetes mellitus: a multicenter cross-sectional study

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References 34.

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[13]	Zhao Zhengxiao, Liu Lumei, Tang Zihui, Mohammadtursun Nabijan, Lu Linwei, Li Mihui, Lü Yibao, Mo Shuming, Ma Wenjuan, Wang Meng, Wei Ying, Gong Weiyi, Dong Jingcheng. Kidney-Qi deficiency diagnosed by Deng's diagnosis standard was not correlated with aging based on clinical observation of 90 participants [J]. Journal of Traditional Chinese Medicine, 2019, 39(02): 267-274.
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