Relationship between Traditional Chinese Medicine Syndrome Elements and Prognosis of Patients with IgA Nephropathy

Jianghua Ke; Shuwei Duan; Linchang Liu; Zhiwei Yin; Shuang Li; Yujing Ke; Jin Yao; Ying Zheng; Weiguang Zhang; Yilun Qu; Ping Li; Zheyi Dong; Xiangmei Chen

doi:10.1155/2022/2270406

Relationship between Traditional Chinese Medicine Syndrome Elements and Prognosis of Patients with IgA Nephropathy

Evid Based Complement Alternat Med. 2022 Jul 30:2022:2270406. doi: 10.1155/2022/2270406. eCollection 2022.

Authors

Jianghua Ke^#^{1

2}, Shuwei Duan^#¹, Linchang Liu¹, Zhiwei Yin¹, Shuang Li¹, Yujing Ke^{1

2}, Jin Yao^{1

2}, Ying Zheng¹, Weiguang Zhang¹, Yilun Qu^{1

2}, Ping Li¹, Zheyi Dong¹, Xiangmei Chen^{1

2}

Affiliations

¹ National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, Beijing 100853, China.
² School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China.

^# Contributed equally.

Abstract

Objective: It is not clear which Traditional Chinese Medicine- (TCM-) related elements affect primary IgA nephropathy (IgAN) progression. Here, we explored the risk factors, based on TCM syndrome elements, related to the prognosis of primary IgAN patients.

Methods: We analyzed patients with newly diagnosed, biopsy-proven IgAN at a single institution from December 2013 to September 2021. Basic clinical and pathological characteristics were assessed at the time of renal biopsy. The study endpoint was end-stage renal disease (ESRD: eGFR <15 ml/min per 1.73 m², dialysis, or kidney transplantation) and/or eGFR decreased by >30% from baseline. Kaplan‒Meier survival analysis was used to explore the role of TCM syndrome elements in IgAN progression. Multivariate Cox regression analysis with adjustment for traditional risk factors was performed to explore TCM syndrome elements that may influence patient prognosis. The factors correlated with TCM syndrome elements in IgAN patients were further evaluated by logistic regression analysis.

Results: During a median follow-up of 22.0 months, 53 (12.5%) of the 423 included IgAN patients reached the study endpoint. The main IgAN disease location elements were the kidney, liver, and spleen. The main IgAN disease nature elements were Yin-deficiency and Qi-deficiency, dampness, Yang-deficiency, phlegm, and Blood-deficiency. Kaplan‒Meier analysis identified three disease locations (liver, spleen, and kidney) and four disease natures (Qi-deficiency, Yang-deficiency, phlegm, and dampness) as elements associated with poor renal survival in IgAN patients. In multivariate Cox regression analysis, baseline Yang-deficiency was an independent risk predictor of poor prognosis in primary IgAN patients (hazard ratio 2.338; 95% confidence interval [CI]: 1.208-4.525; P=0.012) after adjustment for traditional risk factors. Furthermore, logistic regression analysis identified being female (odds ratio [OR] 2.518; 95% CI: 1.538-4.122; P < 0.001), older age (OR 1.043; 95% CI: 1.022-1.065; P < 0.001), low hemoglobin levels (OR 0.984; 95% CI: 0.971-0.996; P=0.013), and cellular/fibrocellular crescents (OR 1.706; 95% CI: 1.068-2.728; P=0.026) as factors affecting Yang-deficiency in IgAN patients.

Conclusions: Yang-deficiency independently predicts the risk of poor prognosis in primary IgAN patients. Being female, older age, low hemoglobin levels, and cellular/fibrocellular crescents were independently associated with Yang-deficiency in IgAN patients.