Factor analysis of Traditional Chinese Medicine syndromes and clinical characteristics of patients with secondary hyperparathyroidism maintained by hemodialysis: A cross-sectional study

Introduction: Secondary hyperparathyroidism (SHPT) causes damage to skeletal, cardiovascular, and nervous systems and is common in the maintenance of hemodialysis (MHD) patients. This study explored association between the clinical characteristics of traditional Chinese medicine (TCM) syndromes in MHD patients with SHPT. Methods: Eligible patients were identified from two hemodialysis centers in Wuhan, Hubei, China between June 2019 and December 2019. All participants were requested to complete questionnaires containing demographic and clinical information. TCM syndrome was defined by the physicians. Laboratory parameters were abstracted by medical records review. Multivariate logistic regression and ridge regression were applied to identify factors associated with SHPT.Sensitivity analysis was adopted to test robustness of results. Results: A total of 177 MHD patients were recruited. Multivariate logistic regression indicated Yang deficiency of the spleen and kidney syndrome (OR 2.768; 95%CI 1.074-7.134); male (OR 2.525; 95%CI 1.110-5.744); hypocalcemia (OR 0.158; 95%CI 0.028-0.897); the elevation of serum creatinine (OR 1.003; 95%CI 1.002-1.005), alkaline phosphatase (OR 1.018; 95%CI 1.008-1.029) and neutrophil to lymphocyte ratio (OR 2.101; 95%CI 1.462-3.020) level appeared to be factors associated with SHPT in MHD patients. Ridge regression suggested dialysis duration was one of the factors of SHPT, others were the same as logistic regression results. Sensitivity analysis showed the association between gender and SHPT was not significant. Conclusion: Yang deficiency of the spleen and kidney syndrome, systemic inflammation, hypocalcemia, elevated serum creatinine and alkaline phosphatase level appeared to be associated with SHPT in MHD patients. These results demonstrate an integrated traditional Chinese and western medicine perspective.