THE TCM SYNDROMES OF PATIENTS WITH CKD-MBD IN STAGE 5D AND THEIR RELATIONSHIP WITH KLOTHO AND FGF23 LEVELS

Jianjing Liu, Meixiao Sheng^*, Jinhui Song, Lei Yin, Liuxia Hu, Liming Fang

Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

Objective: To analyze Traditional Chinese Medicine (TCM) syndromes in dialysis patients with Chronic Kidney Disease-Mineral and Bone Disorder in stage 5 (CKD-MBD stage 5D) and their relationship with FGF23 levels and Klotho protein. 

Methods: A total of 154 patients eligible for inclusion were collected, and a survey was conducted to observe laboratory indexes, including FGF23, Klotho, calcium, and phosphorus, as well as to analyze the characteristics of TCM syndrome types and their relationship with FGF23 and Klotho. 

Results: (A) In this study, 154 patients with CKD-MBD stage 5D showed a higher percentage in symptoms of liver-and-kidney-yin-deficiency syndrome, spleen-and-kidney-qi-deficiency syndrome, spleen-and-kidney-yang deficiency and blood stasis. Furthermore, liver-and-kidney-yin-deficiency syndrome and blood stasis were the TCM syndrome types most commonly seen; (B) Compared with the healthy control group, the serum FGF23 level and FGF23/Klotho ratio of all patients significantly increased, while the Klotho level decreased (P<0.05); and (C) The level of serum FGF23 and FGF23/Klotho ratio of patients in the spleen-and-kidney-qi-deficiency group and the damp heat group was higher than that of other groups, while the Klotho level was lower than that of the other groups (P<0.05). 

Conclusion: In patients with CKD-MBD stage 5D, syndromological syndromes that are most commonly seen include liver-and-kidney-yin-deficiency, spleen-and-kidney-qi-deficiency and spleen-and-kidney-yang-deficiency. Additionally, symptomatic syndrome is mostly manifested as blood stasis syndrome, while an increase in FGF23 and decrease in serum Klotho protein have a close connection with spleen-and-kidney-qi-deficiency and damp heat syndrome.