Colonic Dialysis Research Articles

Exploring the clinical efficacy and mechanism of high-position colon dialysis combined with Traditional Chinese Medicine retention enema in real-world patients with stage 3-5 chronic kidney disease (non-dialysis) based on the theory of the Gut-Kidney axis.

Background: With societal and economic development, the annual incidence of chronic kidney disease (CKD) is increasing. Current treatments for CKD are limited, and once patients progress to the uraemic stage, it places a significant economic burden on families and society. Based on the "gut-kidney axis" theory and real-world research, this study aims to evaluate the clinical efficacy, safety, and potential mechanism of high-position colon dialysis combined with traditional Chinese medicine (TCM) retention enema in treating stage 3-5 chronic kidney disease (non-dialysis). Additionally, it seeks to identify new therapeutic targets and approaches for CKD treatment. Methods: The TCM decoction was analyzed using Ultra-Performance Liquid Chromatography-Quadrupole-Orbitrap-High Resolution Mass Spectrometry (UPLC-Q-Orbitrap-HRMS). Participants meeting the inclusion criteria were divided into a control group (n = 153) and a treatment group (n = 159) based on their preferences and physicians' recommendations. Both groups adhered to a high-quality low-protein, low-salt, low-phosphorus, and low-fat diet supplemented with essential amino acids, and were monitored for blood pressure, blood glucose, and blood lipids. The treatment group received high-position colon dialysis combined with TCM retention enemas (administered at least 12 times every other day). Results: Thirteen compounds were identified from the herbs by UPLC-Q-Orbitrap-HRMS. The CKD3-5 treatment group exhibited improvements in blood biochemistry and other laboratory indices, with significant enhancements in renal function-related indices for CKD4 and CKD5 stages (p < 0.05). Following treatment, indoxyl sulfate (IS), endotoxin, and D-lactic acid levels decreased to a certain extent in both groups, with a statistically significant difference observed within the treatment group (p < 0.05). The treatment group displayed a significant reduction in aerobic bacterial colonies, an increase in anaerobic bacterial colonies, a decrease in Escherichia coli colonies, and an increase in Bifidobacterium and Lactobacillus colonies (p < 0.05). No significant changes in colony numbers were observed in the control group. Conclusion: High-position colon dialysis combined with TCM retention enema may serve as an adjuvant treatment for CKD4-5 (non-dialysis), and its mechanism may be related to the reduction of uraemic toxins, improvement of intestinal mucosal barrier function, and regulation of intestinal microecology. Clinical Trial Registration: https://www.chictr.org.cn/, identifier ChiCTR2200062852.

Treatment of Metabolic Associated Fatty Liver Disease with Traditional Chinese Medicine Colon Dialysis Based on "Gut-liver Axis"

Treatment of Metabolic Associated Fatty Liver Disease with Traditional Chinese Medicine Colon Dialysis Based on "Gut-liver Axis"

Obesity influences the microbiotic biotransformation of chlorogenic acid

Obesity is a major public health problem. Gut microbiome dysbiosis has been associated with obesity, however, little is known on the effect of the dysbiosis on the microbiotic bio-transformation of xenobiotics. Fecal samples of lean (n = 9) and obese (n = 4) female volunteers were collected and characterized by 16 S rDNA gene sequencing. The microbiotic biotransformation of chlorogenic acid was studied using the collected fecal samples of lean and obese subjects in the colon stage of the gastro-intestinal dialysis model with colon stage (GIDM-Colon). The concentration of anaerobic bacteria was lower for all obese samples in comparison to the samples of the lean volunteers. Differences in gut microbiome composition and bacterial concentration were observed between the two populations. The obese gut microbiome presented a lower metabolic activity in comparison to the lean population. Chlorogenic acid was completely biotransformed after 24 h colonic dialysis in the lean population while it was still present in the obese population. Furthermore, 23 and 13 biotransformation products were identified in the lean and obese population, respectively; 11 unique biotransformation products from the caffeic, feruoylquinic and quinic acid pathways were identified in the lean population. The results confirm that changes in gut microbiota related to obesity are associated with differences in microbiotic biotransformation of xenobiotics and thus possibly influencing the activity, bioavailability and toxicity of orally administered xenobiotics and drugs.

Efficacy and safety of colonic dialysis combined with traditional Chinese medicine retention enema in the treatment of chronic renal failure: A protocol for systematic review and meta-analysis.

Background:Chronic renal failure (CRF) is a major public health problem worldwide nowadays. It is characterized by a slow reduction in kidney function identified by an increase of serum creatinine levels and a reduction of urine output. CRF is easier to diagnose than to treat. Clinical evidence shows that colonic dialysis combined with traditional Chinese medicine (TCM) enema can treat CRF by reducing serum creatinine. To assess the therapeutic efficacy and safety of colonic dialysis combined with Traditional Chinese medicine retention enema in CRF, we created a protocol for a systematic review to inform future clinical applications.Methods:Eligible random controlled trials were collected from 8 bibliographic databases (PubMed, EMBASE, Web of Science, The Cochrane Library, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang Database), completed before October 2021. The primary outcome is the serum creatinine, Urea nitrogen, total effective rate, uric acid, creatinine clearance. Secondary outcome: TCM syndrome score, glomerular filtration rate, hemoglobin, adverse reactions, and adverse events. Data extraction and quality assessment were independently conducted by 2 researchers. The quality and bias of the data were assessed using RevMan5.4 software.Results:This study will provide a clinical basis for colonic dialysis combined with TCM retention enema in the treatment of CRF.Conclusion:Colonic dialysis combined with TCM retention enema in the treatment of CRF can delay the progression of renal disease, proving its effectiveness and safety.INPLASY Registration number:INPLASY2021100116

Risk Factors and Management of Catheter Malfunction During Urgent-Start Peritoneal Dialysis.

Background: Catheter malfunction is a common complication of peritoneal dialysis (PD). This study aimed to retrospectively analyze the risk factors and management of catheter malfunction in urgent-start PD.Methods: Patients who underwent urgent-start PD were divided into catheter-malfunction and control groups. Baseline demographic and laboratory data of the two groups were compared, and the risk factors for catheter malfunction were analyzed. Primary outcome measure was catheter survival, and the secondary outcomes were surgical complications and malfunction treatment.Results: Total of 700 patients was analyzed, among whom 143 (20.4%) experienced catheter malfunctions, specifically catheter migration (96, 67.1%), omental wrapping (36, 25.2%), and migration plus omental wrapping (11, 7.7%). Catheter survival time in the malfunction group (202.5 ± 479.4 days) was significantly shorter than that in the control group (1295.3 ± 637.0 days) (P < 0.001). Multivariate analysis revealed higher body mass index [hazard ratio (HR), 1.061; 95% confidence intervals (CI), 1.010–1.115; P = 0.018], lower surgeon count (HR, 1.083; 95% CI, 1.032–1.136; P = 0.001), and higher serum potassium (HR, 1.231; 95% CI, 1.041–1.494; P = 0.036) as independent risk factors for catheter malfunction, while older age (HR, 0.976, 95% CI, 0.962–0.991; P = 0.002) and colonic dialysis (HR, 0.384; 95% CI, 0.254–0.581; P < 0.001) as protective factors. Further subgroup analysis revealed a shorter catheter survival time in patients with younger age ( ≤ 40 years), higher serum potassium levels (≥5 mmol/L), while a longer catheter survival time in patients with colonic dialysis. PD tube and subcutaneous tunnel preservation was successful in 41 out of 44 patients with omental wrapping. All patients had good post-incision prognoses.Conclusions: Urgent-start PD is safe and effective for unplanned PD patients. Adequate pre-operative colonic dialysis and serum potassium level control are conducive in preventing catheter malfunction. Conservative treatment is effective in managing catheter migration alone, while preservation of the PD tube and the subcutaneous tunnel is effective for omental wrapping.

Colonic dialysis can influence gut flora to protect renal function in patients with pre-dialysis chronic kidney disease

Chronic kidney disease (CKD) is a major public health burden around the world. The gut microbiome may contribute to CKD progression and serve as a promising therapeutic target. Colonic dialysis has long been used in China to help remove gut-derived toxins to delay CKD progression. Since disturbances in the gut biome may influence disease progression, we wondered whether colonic dialysis may mitigate the condition by influencing the biome. We compared the gut microbiota, based on 16S rRNA gene sequencing, in fecal samples of 25 patients with CKD (stages 3–5) who were receiving colonic dialysis(group CD), 25 outpatients with CKD not receiving colonic dialysis(group OP), and 34 healthy subjects(group HS). Richness of gut microbiota was similar between patients on colonic dialysis and healthy subjects, and richness in these two groups was significantly higher than that in patients not on colonic dialysis. Colonic dialysis also altered the profile of microbes in the gut of CKD patients, bringing it closer to the profile in healthy subjects. Colonic dialysis may protect renal function in pre-dialysis CKD by mitigating dysbiosis of gut microbiota.

Novel conservative management of chronic kidney disease via dialysis-free interventions.

In advanced chronic kidney disease (CKD) patients with progressive uremia, dialysis has traditionally been the dominant treatment paradigm. However, there is increasing interest in conservative and preservative management of kidney function as alternative patient-centered treatment approaches in this population. The primary objectives of conservative nondialytic management include optimization of quality of life and treating symptoms of end-stage renal disease (ESRD). Dietetic-nutritional therapy can be a cornerstone in the conservative management of CKD by reducing glomerular hyperfiltration, uremic toxin generation, metabolic acidosis, and phosphorus burden. Given the high symptom burden of advanced CKD patients, routine symptom assessment using validated tools should be an integral component of their treatment. As dialysis has variable effects in ameliorating symptoms, palliative care may be needed to manage symptoms such as pain, fatigue/lethargy, anorexia, and anxiety/depression. There are also emerging treatments that utilize intestinal (e.g., diarrhea induction, colonic dialysis, oral sorbents, gut microbiota modulation) and dermatologic pathways (e.g., perspiration reduction) to reduce uremic toxin burden. As dialysis may not confer better survival nor improved patient-centered outcomes in certain patients, conservative management is a viable treatment option in the advanced CKD population.

Anephric Neonate and Evolution of our Study on Intestinal Dialysis.

Purpose:Intestinal dialysis for end-stage renal disease (ESRD) is a proposed renal replacement therapy, and studies are going on worldwide to make it practicable. We are also doing the same study in our institution and would like to share our experience in managing an anephric neonate with intestinal dialysis in the perspective of our ongoing study of intestinal dialysis since 2010.Patients and Methods:We did double-ended jejunostomy in an isolated loop of the jejunum keeping the main tract intact with jejunojejunal anastomosis in this anephric neonate. Following that, we started irrigation with peritoneal dialysis fluid from the 3rd postoperative day (POD) in that jejunal loop through jejunostomy.Results:This patient had no uremic features since re-admission and showed better laboratory and clinical outcomes with combined jejunal loop and colonic dialysis for 7 days. However, the patient died on the 9th POD following severe hypoglycemia.Conclusions:From this study, it seems intestinal dialysis, with necessary modifications done in our subsequent patients, which might be recommended for ESRD in children as well as in adults.

Influence of Colonic Dialysis on the Distribution of Gut Microbiome in CKD Stage 3-5 Patients

Influence of Colonic Dialysis on the Distribution of Gut Microbiome in CKD Stage 3-5 Patients

Influence of colonic dialysis using Gubenxiezhuo on the distribution of gut microflora in uremia rats.

This study aimed to explore the underlying function of Gubenxiezhuo dialysis on the distribution of gut microflora uremia. A uremia rat model was constructed, and the morphology of renal tissue was determined using the hematoxylin-eosin (H&E) staining. Moreover, the blood samples were collected and the expression of IL-1β, IL-6, and CRP was determined using enzyme-linked immunosorbent assay. Following these experiments, the gut tissues of rats were collected and the distribution of gut microbiota was explored using real-time PCR. Compared with the control group, inflammatory infiltration, apoptosis, and bleeding were significantly upregulated in kidney of uremia rats, and Gubenxiezhuo dialysis could obviously ameliorate these changes. Expression of IL-1β, IL-6, and CRP were significantly elevated in uremic rats and Gubenxiezhuo could significantly attenuate these elevations (p < 0.01). In addition, Gubenxiezhuo dialysis also could attenuate the upregulations of Acinetobacter, Bacillus cereus, Proteus vulgaris, Shigella flexneri, and Escherichia coli , and the downregulation of Bifidobacterium, Lactobacillus, and Helicobacter in the uremia rats ( p < 0.05). Gubenxiezhuo dialysis could significantly ameliorate the inflammatory to modulate the distribution of gut microbiota in uremia.

Establishment of colonic dialysis model in uremic rats by right nephrectomy and left partial nephrectomy

Conventional treatments for patients suffering with end-stage renal disease (ESRD) has several disadvantages, highlighting the importance of other reproducible modalities such as colonic dialysis (CD). The aim was to establish a CD model in uremic rats and evaluate the effect of two different peritoneal dialysis (PD) solutions. Thirty-two male Wistar rats were randomly divided into four groups. After right nephrectomy and left partial nephrectomy, a Malone antegrade continence enema (MACE) stoma was created. Seven days after the procedure, blood sampling was performed. In group I (N=8) no postoperative intervention was performed. In group II (N=8), CD was started through the MACE stoma by a low osmolar PD solution. Rats of group III (N=8) underwent the same procedure with a high osmolar PD solution. Rats of group IV (N=8) underwent CD without nephrectomy in order to evaluate the feasibility of this technique. Mannitol and activated charcoal were also added to both PD solutions. Weekly blood sampling was performed in order to evaluate the plasma creatinine and blood urea nitrogen (BUN) level. In rats of the control group, the respective mean±SD creatinine level was 1.5±0.04mg/dL, 7 days after the surgical procedure, but a lower creatinine level was found in groups II and III (0.8±0.02 and 0.5±0.03, respectively). Despite the fact that the creatinine level was in steady low states after regular CD in group II (1±0.05) and group III (0.6±0.02), it remained at higher levels in the control group (1.7±0.08) 2 weeks postoperatively. Rats of group I did not survive until the third postoperative week, while the creatinine level was still lower in group III than in group II (0.6±0.02 vs. 1.1±0.03). Similar results were obtained for the BUN level at these timepoints. The mean±SD survival period was 11±2, 20±3, and 33±2 days in the animals of groups I, II, and III, respectively. To the best of our knowledge, this is the first study of CD establishment in a rat model. Unfortunately, the amount of protein loss, elevation of blood glucose levels, and electrolyte disturbance were not evaluated in the current study because of the limited amount of blood samples. Disturbance of these factors might be a cause of mortality in experimental groups undergoing CD while a significant decrease in BUN and creatinine levels was obtained. CD with an efficient PD solution through a MACE stoma may be a valuable option when conventional methods are not available.

Relationship between nutritional status and intestinal mucosal immune barrier in patients with stage IV chronic kidney disease: Curative effect of Chinese herbal colon dialysis

Relationship between nutritional status and intestinal mucosal immune barrier in patients with stage IV chronic kidney disease: Curative effect of Chinese herbal colon dialysis

Effect of colon dialysis combined with Chinese medicine enema on hepatic encephalopathy in patients with liver cancer and cirrhosis

Effect of colon dialysis combined with Chinese medicine enema on hepatic encephalopathy in patients with liver cancer and cirrhosis

Curative effect observation on uremic clearance granule combined with colon dialysis in the treatment of chronic renal failure

Objective To observe the clinical efficacy of uremic clearance granule combined with colon dialysis in the treatment of chronic renal failure (CRF) at early and middle stages.Methods 76 cases of CRF in early and middle stage in our hospital were randomly divided into control group and treatment group,two groups underwent 3 courses of treatment.38 cases of the control group,were given routine colon dialysis,38 cases in the treatment group,based on the conventional colon dialysis therapy,were added with uremic clearance granule retention enema.We observed and analyzed the patients of two groups before the first treatment and after the last treatment,detecting the blood urea nitrogen (BUN),serum creatinine (SCr),blood uric acid (UA).Results In the treatment group and the control group after treatment,the BUN,SCr,UA significantly decreased compared with those before treatment,the treatment group decreased significantly compared with that of the control group,showing a significant difference between two groups (P ＜ 0.05).Conclusion Uremic clearance granule combined with colon dialysis in the treatment of CRF patients has better clinical curative effect than the conventional colon dialysis,uremic clearance granule retention enema on CRF treated with colon dialysis has its advantages. Key words: Uremic clearance granule; Chronic renal failure; Colon dialysis

Commentary to “A novel alternative for renal replacement therapy for developing countries: Two-year successful colonic dialysis via malone antegrade continent enema stoma”

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A novel alternative for renal replacement therapy: 2-year successful colonic dialysis via a Malone antegrade continent enema stoma

This study is a case report of home-based colonic dialysis (CD) for treating end-stage renal disease in a 20-year-old woman. She had a history of Malone antegrade continence enema (MACE) for treating neuropathic bowel at the age of 11 years. The patient refused any type of renal replacement therapy. However, she agreed to CD through the MACE stoma by changing the colonic irrigation solution to the peritoneal dialysis solution. The patient was discharged with a plasma creatinine (Cr) level of 1.7 mg/dL and blood urea nitrogen (BUN) level of 8 mg/dL. She has continued CD on a regular basis at home. The patient's serum Cr and BUN has remained in the steady low state during 24 months of follow-up (mean Cr level = 2.8 mg/dL and mean BUN level = 10.7 mg/dL).

Mechanisms and effects of Chinese herbal medicine delaying progression of chronic renal failure

In this review,firstly,it has been discussed the mechanisms of Chinese herbal medicine ameliorating glomerulosclerosis and renal interstitial fibrosis during the progression of chronic renal failure (CRF) by improving glomerular hemodynamics turbulence, podocyte injury, transforming growth factor (TGF)-beta over-expression, hyperlipidemia, macrophage infiltration, tubular epithelial myofibroblast transdifferentiation, and nephrotoxicity of proteinuria. Secondly,it has been reported the clinical effects of Chinese herbal medicine improving renal function and some clinical complications in the patients with progressive CRF through various treatments including oral administration or coloclysis of Chinese herbal medicine, oral administration combined with coloclysis of Chinese herbal medicine, and colonic dialysis combined with coloclysis of Chinese herbal medicine. Finally,it has been reviewed the beneficial influences of Chinese herbal medicine on metabolic dysequilibrium of calcium and phosphonium, microinflammatory state, and uremic toxins in patients with uremia.

Habitual Constipation in the Elderly Treated by Retention-enema with Trigeminy Viable Organism via High-position Colon Dialyzer

Objective Observation and nursing on the habitual constipation in the elderly treated by retention-enema with trigeminy viable organism via high-position colon dialyzer. Methods 60 elderly patients with habitual constipation were divided into two groups randomly, 30 cases respectively. The patients in the observation group were treated by retention-enema with trigeminy viable organism via high-position colon dialyzer, while others by conventional therapy. To compare the improvement on their simultaneous phenomenon of constipation (defecation interval, stool character, exertion effort and so on) and adverse effect. Results The therapeutic effect in the observation group is better than that in the control group and the difference was statistically significant (P < 0. 01 ). Conclusions Retention-enema with trigeminy viable organism via high position colon dialyzer has a good effect on the habitual constipation in the elderly. Key words: Elderly; Constipation; Colon dialysis; Treatment; Nursing

Comparative study on two kinds of bowel preparation for Enteroscopy in aged patients

Objective To compare effection of two kinds of bowel preparation for enteroscopy in aged patients. Methods 100 patients who would receive enteroseopy were divided into two groups. 50 cases in each group. Patients in experimental group received colon dialysis, patients in control group received oral medication. Observed the effectiveness of two kind of bowel preparations and adverse reaction. Results The effectiveness of colon dialysis was superior to oral medication(P <0. 05) ,there was no significant deviation the adverse reaction of two groups. Conclusions Colon dialysis is a suitable method in bowel preparation for enteroscopy in aged patients. Key words: Colonoscopy; Bowel preparation; Colon dialysis; Oral; Aged

The clinical research of inserting depth of colon dialysis

Objective To discuss the effect that the depth of colon dialysis influence on chronic renal failure. Methods 80 cases of chronic renal failure were divided into two groups. The observation group was inserted duct the anus 25～30 cm, the control group was 10～15 cm, the change of Scr, BUN, Hb were observed after two period of treatment. Results The levels of all indexes of the control group were better than those of the obser-vation group after two period of treatment. Conclusions The depth of colon dialysis greatly influences on the levels of Scr, BUN, Fib in the chronic renal failure patients, and it can prolong the keeping time in colon obviously and the frequency of passive defecation is much more. Key words: Colon dialysis; Depth of duct