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Journal of Traditional Chinese Medicine >

2026 , Vol. 46 >Issue 4: 982 - 989

DOI: https://doi.org/10.19852/j.cnki.jtcm.2026.04.018

Original Articles

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 Ruimin ,
  • LI Shuang ,
  • QU Yilun ,
  • WANG Qian ,
  • XIE Huidi ,
  • WANG Xiaolong ,
  • DUAN Shuwei ,
  • WU Jie ,
  • WANG Yong ,
  • DONG Zheyi ,
  • CHEN Xiangmei
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  • 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
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

Received date: 2025-06-03

  Accepted date: 2025-10-27

  Online published: 2026-08-08

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

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

Cite this article

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 . DOI: 10.19852/j.cnki.jtcm.2026.04.018

References

1. Yang C, Wang H, Zhao X, et al. CKD in China: evolving spectrum and public health implications. Am J Kidney Dis 2020; 76: 258-64.
2. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol 2017; 12: 2032-45.
3. Cockwell P, Fisher LA. The global burden of chronic kidney disease. Lancet 2020; 395: 662-4.
4. Guedes M, Pecoits-Filho R. Can we cure diabetic kidney disease? Present and future perspectives from a nephrologist's point of view. J Intern Med 2022; 291: 165-80.
5. Zhao X, Niu Q, Gan L, et al. Baseline data report of the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Sci Rep 2021; 11: 873.
6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105: S117-314.
7. Chinese Society of Nephrology. Chinese guidelines for renal replacement therapy in diabetic end-stage renal disease. Zhong Hua Shen Zang Bing Za Zhi 2022; 38: 62-75.
8. Wu Y, Li C, Zhang L, et al. Effectiveness of Chinese herbal medicine combined with Western Medicine on deferring dialysis initiation for nondialysis chronic kidney disease stage 5 patients: a multicenter prospective nonrandomized controlled study. Ann Transl Med 2021; 9: 490.
9. Liu YW, Hsu YT, Lee WC, Tsai MY. Review of Traditional Chinese Medicines for common complications related to hemodialysis: an evidence-based perspective. Evid Based Complement Alternat Med 2021; 2021: 9953986.
10. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-53.
11. Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158: 825-30.
12. Committee of the Society of Internal Medicine of the Chinese Society of Traditional Chinese Medicine. Criteria for TCM staging, syndrome differentiation and curative effect evaluation of diabetes mellitus (diabetes mellitus). Zhong Guo Yi Yao Xue Bao 1993; 3: 54-6.
13. Zheng XY. Guiding principles for clinical research of new Traditional Chinese Medicine. Beijing: China Medical Science and Technology Press, 2002: 233-7.
14. Chinese Society of Traditional Chinese Medicine. Guidelines for Traditional Chinese Medicine prevention and treatment of Diabetes. Zhong Guo Zhong Yi Yao Xian Dai Yuan Cheng Jiao Yu 2011; 4: 151-3.
15. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-12.
16. Mathur VS, Wesson DE, Li E, Tangri N. Factors affecting the decision to initiate dialysis: a national survey of United States nephrologists. Am J Nephrol 2022; 53: 722-9.
17. Jia X, Tang X, Li Y, Xu D, Moreira P. Update of dialysis initiation timing in end stage kidney disease patients: is it a resolved question? A systematic literature review. BMC Nephrol 2023; 24: 162.
18. Kurella Tamura M, O'Hare AM, McCulloch CE, Johansen KL. Signs and symptoms associated with earlier dialysis initiation in nursing home residents. Am J Kidney Dis 2010; 56: 1117-26.
19. Wongrakpanich S, Susantitaphong P, Isaranuwatchai S, Chenbhanich J, Eiam-Ong S, Jaber BL. Dialysis therapy and conservative management of advanced chronic kidney disease in the elderly: a systematic review. Nephron 2017; 137: 178-89.
20. Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010; 363: 609-19.
21. Fu EL, Evans M, Carrero JJ, et al. Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study. Bmj 2021; 375: e066306.
22. Xu XD, Han X, Yang Y, Li X. Comparative study on the efficacy of peritoneal dialysis and hemodialysis in patients with end-stage diabetic nephropathy. Pak J Med Sci 2020; 36: 1484-9.
23. Ling J, Ng JKC, Chan JCN, Chow E. Use of continuous glucose monitoring in the assessment and management of patients with diabetes and chronic kidney disease. Front Endocrinol (Lausanne) 2022; 13: 869899.
24. Vanek L, Gülmez D, Kurnikowski A, et al. Patient and caregiver perspectives on gender disparity in chronic kidney disease: questionnaire survey, based on an interview study. Am J Nephrol 2024; 55: 561-82.
25. Zhao X, Gan L, Niu Q, et al. Clinical outcomes in patients on hemodialysis with congestive heart failure. Kidney Dis (Basel) 2023; 9: 306-16.
26. Liu S, Cui Z, Liu Z, et al. Changes of TCM syndromes in CKD stage 5 patients before and after hemodialysis. Zhong Guo Zhong Xi Yi Jie He Shen Bing Za Zhi 2012; 13: 52-3.
27. Li X. Discussion on the changes of TCM syndromes in hemodialysis patients with end-stage renal disease. Hang Kong Hang Tian Yi Xue Za Zhi 2022; 33: 1409-12.
28. Gai C, Liao K, Huang P, et al. Analysis of the changes of TCM syndromes before and after hemodialysis in patients with end-stage renal disease. Zhong Guo Shi Yong Yi Yao 2020; 15: 132-4.
29. Chinese Association of Integrative Medicine, China Association of Chinese Medicine, Chinese Medical Association. Guidelines for diagnosis and management of diabetic kidney disease with integrated Traditional Chinese and Western Medicine. China Association of Chinese Medicine online, 2023-05-31, cited 2026-06-23; 25. Available from URL: https://www.cacm.org.cn/2023/05/31/23420/.
30. Yuan L, Xiao Y, Zhong J, et al. Exploration of TCM syndrome elements in hemodialysis patients based on factor analysis. Shi Jie Zhong Yi Yao 2020; 15: 2325-30.
31. Gao G, Sun W. TCM syndrome research of chronic kidney disease based on the theory of "kidney deficiency and damp-blood stasis". Shi Jie Ke Xue Ji Shu-Zhong Yi Yao Xian Dai Hua 2021; 23: 3474-82.
32. Wang Y, Zhang L, Wu J, et al. Analysis of professor Liu Guangzhen's experience in treating chronic kidney disease. Hunan Zhong Yi Yao Da Xue Xue Bao 2022; 42: 453-6.
33. Pinto J, Debowska M, Gomez R, Waniewski J, Lindholm B. Urine volume as an estimator of residual renal clearance and urinary removal of solutes in patients undergoing peritoneal dialysis. Sci Rep 2022; 12: 18755.
34. Evans M, van Stralen KJ, Sch?n S, et al. Glomerular filtration rate-estimating equations for patients with advanced chronic kidney disease. Nephrol Dial Transplant 2013; 28: 2518-26.
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