Liu Xinyin, Wang Xiaoran, Ma Hongzhen, Zhang Wen
The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Nephrology, The First People's Hospital of Hangzhou Lin'An District, Hangzhou, China.
Front Nephrol. 2022 Nov 9;2:1006506. doi: 10.3389/fneph.2022.1006506. eCollection 2022.
Chronic kidney disease (CKD) is associated with high incidence, low awareness, and high disability rates among the population. Moreover, the disease significantly affects the physical and mental health of patients. Approximately 25% of patients with CKD develop end-stage renal disease (ESRD) within 20 years of diagnosis and have to rely on renal replacement therapy, which is associated with high mortality, heavy economic burden, and symptoms including fatigue, pain, insomnia, uremia pruritus, and restless leg syndrome. Currently, the means to delay the progress of CKD are insufficient; therefore, developing strategies for delaying CKD progression has important practical implications. In recent years, more and more people are accepting the traditional Chinese medical technique "acupuncture." Acupuncture has been shown to improve the uncomfortable symptoms of various diseases through stimulation (needling, medicinal moxibustion, infrared radiation, and acupressure) of acupoints. Its application has been known for thousands of years, and its safety and efficacy have been verified. As a convenient and inexpensive complementary therapy for CKD, acupuncture has recently been gaining interest among clinicians and scientists. Nevertheless, although clinical trials and meta-analysis findings have demonstrated the efficacy of acupuncture in reducing albuminuria, improving glomerular filtration rate, relieving symptoms, and improving the quality of life of patients with CKD, the underlying mechanisms involved are still not completely understood. Few studies explored the correlation between acupuncture and renal pathological diagnosis. The aim of this study was to conduct a literature review summarizing the currently known mechanisms by which acupuncture could delay the progress of CKD and improve symptoms in patients with ESRD. This review help provide a theoretical basis for further research regarding the influence of acupuncture on renal pathology in patients with CKD, as well as the differences between specific therapeutic mechanisms of acupuncture in different renal pathological diagnosis. The evidence in this review indicates that acupuncture may produce marked effects on blocking and reversing the critical risk factors of CKD progression (e.g., hyperglycemia, hypertension, hyperlipidemia, obesity, aging, and anemia) to improve the survival of patients with CKD mechanisms including oxidative stress inhibition, reducing inflammatory effects, improving hemodynamics, maintaining podocyte structure, and increasing energy metabolism.
慢性肾脏病（CKD）在人群中具有高发病率、低知晓率和高致残率。此外，该疾病显著影响患者的身心健康。约25%的CKD患者在确诊后20年内发展为终末期肾病（ESRD），不得不依赖肾脏替代治疗，这与高死亡率、沉重的经济负担以及包括疲劳、疼痛、失眠、尿毒症瘙痒和不安腿综合征等症状相关。目前，延缓CKD进展的手段不足；因此，制定延缓CKD进展的策略具有重要的实际意义。近年来，越来越多的人接受传统中医疗法“针灸”。针灸已被证明可通过刺激（针刺、药物艾灸、红外线辐射和指压）穴位来改善各种疾病的不适症状。其应用已有数千年历史，其安全性和有效性已得到验证。作为一种方便且廉价的CKD辅助疗法，针灸最近在临床医生和科学家中受到越来越多的关注。然而，尽管临床试验和荟萃分析结果已证明针灸在降低蛋白尿、提高肾小球滤过率、缓解症状以及改善CKD患者生活质量方面的疗效，但其潜在机制仍未完全明确。很少有研究探讨针灸与肾脏病理诊断之间的相关性。本研究的目的是进行一项文献综述，总结目前已知的针灸可延缓CKD进展并改善ESRD患者症状的机制。本综述有助于为进一步研究针灸对CKD患者肾脏病理的影响以及针灸在不同肾脏病理诊断中的具体治疗机制差异提供理论依据。本综述中的证据表明，针灸可能对阻断和逆转CKD进展的关键危险因素（如高血糖、高血压、高脂血症、肥胖、衰老和贫血）产生显著作用，以提高CKD患者的生存率，其机制包括抑制氧化应激、减轻炎症作用、改善血流动力学、维持足细胞结构以及增加能量代谢。
