Original Article Traditional Chinese medicine enema combined with high flux hemodialysis improves inflammation and stress response in patients ...
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Int J Clin Exp Med 2020;13(5):3754-3761 www.ijcem.com /ISSN:1940-5901/IJCEM0107277 Original Article Traditional Chinese medicine enema combined with high flux hemodialysis improves inflammation and stress response in patients with uremia Jing Shao Department of Traditional Chinese Medicin, Shengli Hospital, Dongying 257055, Shandong, China Received January 2, 2020; Accepted April 9, 2020; Epub May 15, 2020; Published May 30, 2020 Abstract: Objective: This study aimed to investigate the therapeutic effect of traditional Chinese medicine (TCM) enema combined with high flux hemodialysis in patients with uremia and its improvement of inflammation and oxi- dative stress response. Methods: Ninety patients with uremia in our hospital were randomly divided into study group and control group with 45 cases in each group. The study group was treated with TCM enema combined with high flux hemodialysis, while the control group was treated with high flux hemodialysis alone. The therapeutic effect and the incidence of adverse reactions were observed in the two groups. The levels of serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) were measured by the enzyme-linked immunosorbent assay (ELISA) before and after treatment in the two groups. The levels of serum urea nitrogen (BUN), serum uric acid (SUA), serum creatinine (SCr) were measured by automatic biochemical analyzer before and after treatment in the two groups. Results: The effective rate of treatment in the study group was higher than that in the control group (P
Improvement of inflammation and stress reaction by TCM enema and HF-HD
inflammatory cytokines in large amounts [8]. es, infectious diseases, cardiovascular and ce-
Inflammation is a key factor leading to malnu- rebrovascular diseases; patients with cognitive
trition and vascular diseases in hemodialysis dysfunction and mental disorders; patients
patients. The dialysis disequilibrium syndrome who didn’t cooperate with this study.
could lead to higher morbidity and mortality [9].
Therefore, it is very important to reduce inflam- Treatment scheme
mation and stress response of the patients
with uremia during hemodialysis. Studies have The control group was treated with high flux
shown that high-throughput hemodialysis has hemodialysis by Swabs Dialog + hemodialysis
a good clinical effect on uremia pruritus, and machine (Swabs Medical International Trade
can inhibit the inflammatory response of dialy- Co., Ltd., Shanghai, China) and FX80 high flux
sis patients [10]. dialyzer (Fresenius Medical Care AG & Co.
KGaA). The dialysis fluid was bicarbonate, the
However, there are few studies on the applica- dialysis blood flow was 250-300 mL/min, and
tion of this technique combined with TCM the dialysis fluid flow was 600 mL/min. The
enema for treatment. In this study, TCM enema dialysis was carried out 4 h each time, three
combined with high flux hemodialysis was us- times a week. The study group was treated wi-
ed to treat uremia, and the therapeutic effect th TCM enema combined with high flux hemo-
and its effect on inflammation and oxidative dialysis [12]. The ingredients of TCM were as
stress response were explored. follows: Astragalus propinquus Schischkin 20
g, Angelica sinensis Diels 12 g, Salvia miltior-
Materials and methods rhiza Bge. 15 g, Ophiopogon japonicus Ker-
Gawl. 12 g, Ostrea gigas Thunberg 25 g, Rheum
General data officinale 15 g, and Radix paeoniae rubra 10 g.
400 mL of water was added and boiled to 200
Ninety patients with uremia in our hospital were mL. The decoction was taken for enema, once
randomly divided into study group and control a day, once an hour, one month as a course,
group with 45 cases in each group. There were three courses in total.
21 males and 24 females in the study group,
aged from 35 to 61 years old, with the aver- Evaluation of therapeutic effect
age age of 47.8±8.4 years old. There were 18
males and 27 females in the control group, After 3 months of treatment, the therapeutic
aged from 34 to 59 years old, with the average effects of the two groups were observed.
age of 46.7±8.1 years old. This study has been Evaluation criteria [13]: Markedly effective: the
approved by Ethics Committee of Shengli clinical symptoms and signs are completely
Hospital. The subjects and their families sign- disappeared or markedly improved, and the
ed the informed consent. decrease of SCr level is less than 30%. Ef-
fective: the clinical symptoms and signs are
Inclusion and exclusion criteria disappeared or markedly alleviated, and the
decrease of SCr level is less than 20%. Ineffe-
Inclusion criteria: patients meeting the diag- ctive: the clinical symptoms and signs remain-
nostic criteria of uremia [11]; patients who did ed unchanged or even worse, and BUN and
not use immunosuppressive agents; patients SCR levels are increased. Total effective rate =
meeting the criteria of hemodialysis: patients (Markedly effective + effective)/Total number
with blood urea nitrogen (BUN) ≥ 28.6 mmol/L of cases in the group × 100%. The incidence of
or serum creatinine (SCr) ≥ 707.2 mmol/L; adverse reactions during treatment was ob-
patients aged between 34-61 years old. served. The adverse reactions included hypo-
tension, hypoglycemia, disequilibrium syndro-
Exclusion criteria: patients who used the im- me and muscle spasm.
munosuppressive agents or anti-inflammatory
drugs recently; patients with the allergic history Index detection
of cardiopulmonary bypass filters and pipes;
patients with severe cardiopulmonary dysfunc- Before treatment and 3 months after treat-
tion, malignant tumors, recent infections, con- ment, 5 mL of venous blood was extracted and
nective tissue diseases, autoimmune diseas- placed in vacuum blood collection tubes with-
3755 Int J Clin Exp Med 2020;13(5):3754-3761Improvement of inflammation and stress reaction by TCM enema and HF-HD out anticoagulant, and the serum was separat- was used. P
Improvement of inflammation and stress reaction by TCM enema and HF-HD
Table 1. General data of the study group and the control group [n (%)]/(mean ± SD)
Item Study group (n=45) Control group (n=45) t/χ2 value P value
Gender 0.407 0.523
Male 21 (46.67) 18 (40.00)
Female 24 (53.33) 27 (60.00)
Age (years old) 47.8±8.4 46.7±8.1 0.632 0.529
BMI (kg/m2) 20.37±2.16 21.15±2.31 1.654 0.102
Course of disease (year) 1.2±0.5 1.1±0.7 0.780 0.438
Types of primary diseases 0.867 0.648
Diabetic nephropathy 7 (15.56) 9 (20.00)
Chronic glomerulonephritis 29 (64.44) 30 (66.67)
hypertensive renal atherosclerosis 9 (20.00) 6 (13.13)
Dialysis time (month) 22.6±1.8 22.3±1.5 0.859 0.393
Degree of anemia 0.547 0.761
Mild 14 (31.11) 13 (28.89)
Severe 24 (53.33) 27 (60.00)
Severe 7 (15.56) 5 (11.11)
Smoking history 0.865 0.352
Yes 11 (24.44) 15 (33.33)
No 34 (75.56) 30 (66.67)
Drinking history 0.403 0.525
Yes 22 (48.89) 19 (42.22)
No 23 (51.11) 26 (57.78)
Residence 0.450 0.502
City 39 (86.67) 41 (91.11)
Town 6 (13.33) 4 (8.89)
TC (mmol/L) 4.21±1.12 4.16±1.07 0.216 0.829
TG (mmol/L) 1.48±0.63 1.39±0.74 0.621 0.536
HDL (mmol/L) 1.03±0.48 1.08±0.45 0.510 0.612
LDL (mmol/L) 2.31±0.76 2.19±0.73 0.764 0.447
Table 2. Comparison of the levels of serum CRP and TNF-α between the study group and the control
group before and after treatment (mean ± SD)
CRP (mg/L) TNF-α (ng/L)
Group n before after t value P value before after t value P value
treatment treatment treatment treatment
Study group 45 7.56±2.62 4.51±1.64 6.619Improvement of inflammation and stress reaction by TCM enema and HF-HD
Table 3. Comparison of the levels of serum MDA and SOD between the study group and the control
group before and after treatment (x ± SD)
MDA (nmol/L) SOD (IU/mL)
Group n before after t value P value before after t value P value
treatment treatment treatment treatment
Study group 45 5.50±0.34 4.34±0.38 15.260Improvement of inflammation and stress reaction by TCM enema and HF-HD
Table 6. Comparison of the incidence of adverse reactions between the study group and the control
group [n (%)]
Group n Hypotension Hypoglycemia Disequilibrium syndrome Muscle spasm Incidence rate (%)
Study group 45 1 (2.22) 0 (0.00) 0 (0.00) 2 (4.44) 6.67
Control group 45 3 (6.67) 2 (4.44) 1 (2.22) 1 (2.22) 15.56
χ2 value - 1.047 2.045 1.011 0.345 1.800
P value - 0.306 0.153 0.315 0.557 0.180
the oxygen free radicals, which can protect tis- and there was no significant adverse reacti-
sues and cells and reduce the damage caus- ons during treatment, which is similar to our
ed by oxygen free radicals [27]. After treat- study. Rheum officinale, as the principal drug
ment, the levels of CRP, TNF-α and MDA in the of TCM enema, can effectively inhibit the pro-
study group were lower than those in the con- liferation of mesangial cells [22], make a lar-
trol group, and the level of SOD was higher, ge amount of nitrogen excretion, improve lipid
which suggested that TCM enema combined and protein metabolism, and then improve glo-
with high flux hemodialysis can alleviate in- merular filtration rate.
flammation and oxidative stress response in
the patients with uremia. In the study of Lu et It is confirmed that TCM enema combined with
al. [28], Rheum officinale enemas can impro- high flux hemodialysis has obvious benefits in
ve tubulointerstitial fibrosis in 5/6Nx rats by the treatment of uremia in this study. However,
reducing toxin overload, oxidative stress and there are still some deficiencies in this study.
inflammatory damage of kidney. Rheum offici- The residual renal function and the quality of
nale enema can regulate immune function, life of patients have not been observed. The-
improve endocrine function, correct gastroin- se deficiencies need to be improved in future
testinal dysfunction, decrease the levels of mo- studies.
lecular substances in blood, reduce the accu-
In conclusion, TCM enema combined with high
mulation of toxins in the body, thus reduce
flux hemodialysis can improve the therapeutic
inflammatory reaction and oxidative stress re-
effect of uremia and reduce inflammation and
sponse and improve the hemodialysis effect
oxidative stress response.
[29, 30].
Disclosure of conflict of interest
In recent years, TCM enema in the treatment
of uremia has made great progress [18, 19]. None.
TCM enema can preserve the decoction in the
rectum or the colon. Zou et al. [20] reported Address correspondence to: Jing Shao, Depart-
that TCM enema combined with hemodialysis ment of Traditional Chinese Medicin, Shengli Hos-
in the treatment of chronic renal failure can pital, NO. 107 North Second Road, Dongying
accelerate intestinal absorption kinetics. In th- 257055, Shandong, China. Tel: +86-0546-8811-
is study, the patients were treated with TCM 595; E-mail: fhfk5e@163.com
enema combined with hemodialysis. The re-
sults revealed that the effective rate of treat- References
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