Status of Dhātu sāratā (the Level of Tissue Excellence) and its Association with Deha prakṛti (Body Constitution) in Patients with Chronic Kidney Disease

Abstract

At present, Chronic kidney disease (CKD) has emerged as a significant global health concern even in Sri Lanka. The statistical data regarding the increased incidence and prevalence rate of CKD have already proven that there is still no identification of a permanent cure or solution instead of renal replacement therapy for disease management. This remains a tremendous challenge for Western and Āyurveda medical systems. Although the Āyurveda medical system is well nourished by its own concepts such as Dhātu sāratā (tissue excellence), Deha prakṛti (body constitution), which can potentially contribute to the prevention and management of CKD, their clinical applicability appears to be limited. Therefore, this study was planned to assess the status of Dhātu sāratā (the level of tissue excellence) and its association with Deha prakṛti (body constitution) in patients with CKD – Western Province, Sri Lanka. This is a prospective observational case – control study. University Nephrology Clinic at the National Hospital, Sri Lanka and the Renal Clinic at Bandaranaike Memorial Āyurveda Research Institute, Nawinna, Sri Lanka. 113 patients with a diagnosis of CKD and 122 healthy volunteers residing in the Western Province were enrolled in the study. Dhātu sāratā status of Rasa to Sattva was assessed using a standardized and validated questionnaire and ĀyuSoft software was used to assess the type of Deha prakṛti of the research participants. Data analysis was done by using Microsoft Excel 2007 version and appropriate statistical software. The study results revealed that a majority between 43 – 50 % of CKD patients exhibited a predominance of Madhyama sāra status (moderate level of tissue excellence) for Rasa, Rakta and Māṃsa dhātu. A considerable percentage (over 60%) of patients displayed Avara sāra status (inferior or lower level of tissue excellence) in their subsequent dhātu (including Sattva), commencing from Asthi. Compared to the CKD patients, the number of healthy individuals/ controls with Pravara sāra status (superior level of tissue excellence) of each dhātu and Sattva is substantially high. None of the healthy individuals had Avara sāra status of Dhātu nor Sattva. Furthermore, it was observed that the mean percentage scores of all dhātu (commencing from Rasa to Śukra dhātu) and Sattva sāratā significantly differed according to CKD stages under a 5% level of significance. It was also observed that the status of Dhātu commencing from Rasa to Śukra dhātu and Sattva sāratā was significantly associated with the Deha prakṛti types i.e., Vāta, Pitta and Kapha pradhāna prakṛti in CKD patients – Western Province, Sri Lanka, under a 5 % level of significance.It can be concluded that Dhātu sāratā status including Sattva depends on the type of Deha prakṛti in CKD patients and Sāra status of each Dhātu including Sattva declines from Pravara sāra to Avara sāra as the disease progresses. In addition, the CKD patients with Kapha pradhāna prakṛti type can be considered to have the maximum Deha bala whereas those with Pitta and Vāta pradhāna prakṛti types exhibit average and lowest levels of Deha bala respectively.