Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials

Abstract

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 via mechanisms including oxidative stress inhibition, reducing inflammatory effects, improving hemodynamics, maintaining podocyte structure, and increasing energy metabolism.

Correlation of the caring behaviour of nurses with the motivation of patients undergoing haemodialysis

“…29 Additionally, a correlation between hypertension and the occurrence of CKD has been highlighted, indicating that individuals with hypertension, which often develops in middle age, may have a higher risk of developing CKD. 30,31 Additionally, the potential impact of nutritional intake on CKD has been suggested, with lower haemoglobin levels identified as a potential factor contributing to fatigue in CKD patients. It is important to note that the prevalence of CKD in individuals in their 40s may also be influenced by lifestyle factors such as obesity and trauma, which may contribute to the development of conditions such as osteoarthritis and potentially impact kidney health.…”

“…Additionally, the impact of lack of physical activity on the high mortality rate in end-stage renal disease (ESRD) patients undergoing haemodialysis has been highlighted, indicating the potential influence of physical activity on patient motivation. 31,43 The routine activity of haemodialysis as a renal replacement therapy for CKD patients has also been emphasised, highlighting the long-term and repetitive nature of the treatment, which can influence patient motivation. Additionally, the fear of haemodialysis among patients with low levels of education has been identified as a barrier to treatment adherence and motivation.…”

Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review

“…Five principal strategies were identified. Among these, acupuncture demonstrated considerable promise as a benign and efficacious supplementary therapy for managing pain, enhancing functional capacity and muscular strength, lessening symptoms of restless leg syndrome and uremic pruritus, and bettering the QOL of patients on hemodialysis [ 13 , 19 ]. Nonetheless, additional investigations are imperative to confirm these results and define the ideal parameters for treatment.…”

“…Acupuncture is a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body to stimulate the flow of energy (Qi) and restore balance [ 11 , 12 , 13 ]. The therapeutic effect is believed to be achieved through the modulation of multiple physiological systems and biochemical pathways, as shown in Figure 2 , which describes how acupuncture contributes to pain reduction in ESRD [ 14 , 15 , 16 ].…”

“…Acupuncture is a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body to stimulate the flow of energy (Qi) and restore balance [11][12][13]. The therapeutic effect is believed to be achieved through the mod-Figure 1.…”