Core Factors Affecting The Survival Of Diabetic Nephropathy Patients On Dialysis

According to WHO estimates, the number of diabetic patients worldwide will reach 300 million in 2025 and 370 million in 2030. At the same time, the prevalence of diabetes in China is also rising sharply. According to statistics, the number of diabetic patients in China has reached 92 million, and the number of pre-diabetic patients is as high as 148 million. Among them, the incidence rate is as high as 11.4% among urban residents and 8.2% among rural residents.

Click to Cistanche for kidney disease

Diabetes is extremely harmful to health, and one of its complications, diabetic nephropathy, has become the main cause of end-stage renal disease. The third National Health and Nutrition Examination Survey in the United States showed that the proportion of kidney disease among diabetic patients and non-diabetic patients was 42.3% and 9.4% respectively. The national hemodialysis data registration in 2022 shows that patients with diabetic nephropathy account for 21.1%, and new diabetic nephropathy patients account for 29.9%, exceeding chronic glomerulonephritis for the first time. In addition, the older the patient is at the onset of diabetic nephropathy, the shorter the interval between the discovery of diabetes and the start of dialysis; the younger the patient is at the onset of diabetes, the longer the interval.

diabetic nephropathy dialysis

Renal replacement therapy for diabetic nephropathy includes peritoneal dialysis, hemodialysis, kidney transplantation or combined pancreas-kidney transplantation.

1. Peritoneal dialysis

The peritoneal dialysis prescription recommends 2 L of 1.5% to 4.25% peritoneal dialysate, which should be exchanged 4 times a day, and insulin or potassium chloride should be used as needed. Peritoneal dialysis has complications such as orthostatic hypotension, hyperglycemia, dyslipidemia, infection, malnutrition, ultrafiltration or poor toxin removal.

2. Hemodialysis

Hemodialysis patients with diabetic nephropathy have the following characteristics: (1) Compared with non-diabetic nephropathy patients, patients with diabetic nephropathy have lower serum creatinine levels when starting dialysis; severe anemia; and lower total parathyroid hormone. (2) The main reason for diabetic nephropathy patients to start dialysis is cardiac insufficiency/edema. (3) Temporary central venous catheter is most commonly used when starting dialysis. (4) The 5-year survival rate of maintenance hemodialysis patients with diabetic nephropathy is not ideal. Common causes of death include acute left heart failure combined with pulmonary edema, myocardial infarction, arrhythmia, cerebral infarction, cerebral hemorrhage, infection, diabetic foot, tumors, Malnutrition etc. (5) The 10-year survival rate of maintenance hemodialysis patients with diabetic nephropathy is significantly lower than that of patients with non-diabetic nephropathy (33% vs 60%). Cardiovascular disease is one of the leading causes of high mortality, and malnutrition further increases the risk of death.

Diabetic nephropathy dialysis patients

core factors for survival

The core factors affecting the survival of diabetic patients on dialysis include dialysis timing, dialysis adequacy, dialysis-related complications, nutritional status, dialysis water, and the comprehensive management level of the dialysis center. However, many dialysis workers lack sufficient awareness of this issue. Professor Tu Xiaowen here focuses on the content related to the timing of dialysis and the adequacy of dialysis.

1. Timing of dialysis

A randomized controlled study examined the mortality of early dialysis [estimated glomerular filtration rate (eGFR) 10~15 ml/(min·1.73m2)] and late dialysis [eGFR 5~7 ml/(min·1.73m2)] , the results showed that the difference was not statistically significant. However, dialysis will further increase the incidence of cardiovascular events and mortality in diabetic patients. According to the latest guidelines issued by KDOQI, dialysis treatment should be started when eGFR is close to 10 ml/(min·1.73m2).

2. Adequacy of dialysis

Dialysis adequacy is closely related to complication rates and mortality, and much evidence shows that patients with adequate dialysis have significantly lower mortality rates. Dialysis adequacy depends on the dialysis dose, which is equal to the dialysis time multiplied by the dialysis efficiency. In clinical practice, the easiest thing to adjust is the dialysis time. According to EDTA data, the mortality rate of patients with dialysis time less than 12 h/W is significantly higher than that of patients with dialysis time of more than 12 h/W. In addition, there is also data showing that the risk of death in patients who dialyze 3×3.5 hours per week is twice that of 3×4 hours.

The current problem for dialysis patients in my country is that once their condition improves slightly, they are required to reduce the number of dialysis sessions. At the same time, there are also cases where they are forced to reduce the number of dialysis sessions due to economic factors. This results in long-term inadequate dialysis, which affects patients' quality of life and significantly increases mortality. Therefore, to ensure the adequacy of dialysis and improve the quality of life of dialysis patients, sufficient dialysis time must be guaranteed, and the dialysis time should not be less than 12 hours per week.

Dialysis efficiency is determined by dialyzer area, dialyzer performance parameters, dialysate flow and blood flow. Among them, the dialyzer area is the basis of dialysis efficiency; the performance parameters of the dialyzer determine the solute clearance rate and are an important factor affecting dialysis efficiency. The solute clearance and ultrafiltration rate of the dialyzer increase with increasing blood flow and dialysate flow. The ideal dialysis plan should include the use of a large-area, high-permeability dialyzer, with the blood flow rate maintained at 250 to 300 ml/min and not less than 200 ml/min. KDOQI guidelines recommend that the minimum hemodialysis dose standards are Kt/V ≥ 1.2 and URR ≥ 65%. In order to prevent the hemodialysis dose from not reaching the minimum recommended dose, the set target parameter values are recommended to be Kt/V ≥ 1.3 and URR ≥ 70%.

High-flux hemodialysis is a better blood purification technology. In recent years, high-flux dialysis has been widely used. Dialyzers or hemofilters with ultrafiltration coefficients >14 ml/(h·mmHg) or larger are used for routine dialysis, which increases the clearance of medium and large molecular solutes and changes the solute transport mode from simple diffusion. Transformed into dispersion + convection and adsorption. While emphasizing solute clearance, volume clearance is also critical. Accurate determination of dry body weight and timely adjustment to avoid water retention are important aspects of dialysis adequacy, as well as an important step in reducing mortality and improving quality of life.

In addition, in order to improve the quality of life of diabetic nephropathy patients on dialysis, the following measures should be taken: (1) Improve dialytic hypotension. (2) Control high blood pressure. (3) Improve heart disease. (4) Correct hypoglycemia. (5) Improve malnutrition. (6) Make vascular access as early as possible.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.