The efficacy and safety of self-administered acupressure on respiratory tract infection in chronic kidney disease: a randomized controlled trial

Meifang Liu; Hongqin Sheng; Jiahui Huang; Meiling Xuan; Wenwei Ouyang; Yanmei Zhang; Shuzhen Zhou; Lu Zeng; Lizhe Fu; Yin Chen; Xinyi Huang; Kaiqi Huang; Yifan Wu; Xusheng Liu; Lei Zhang

doi:10.21037/atm-22-2376

The efficacy and safety of self-administered acupressure on respiratory tract infection in chronic kidney disease: a randomized controlled trial

Ann Transl Med. 2022 Jun;10(12):688. doi: 10.21037/atm-22-2376.

Authors

Meifang Liu^{1

2

3}, Hongqin Sheng^{1

2}, Jiahui Huang^{1

2}, Meiling Xuan⁴, Wenwei Ouyang^{4

5}, Yanmei Zhang^{1

2}, Shuzhen Zhou^{1

6}, Lu Zeng^{1

2}, Lizhe Fu², Yin Chen^{1

2}, Xinyi Huang^{1

2}, Kaiqi Huang^{1

2}, Yifan Wu², Xusheng Liu^{1

2

7}, Lei Zhang^{1

2

7}

Affiliations

¹ State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
² Nephrology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
³ The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, Victoria, Australia.
⁴ Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
⁵ Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
⁶ Nephrology Department, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.
⁷ Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China.

Abstract

Background: Respiratory tract infection (RTI) is associated with a higher risk of kidney failure in patients with chronic kidney disease (CKD), without effective precautions. Self-administered acupressure (SAA) has been shown to potentially prevent RTI, but still lack of clinical evidence in CKD. The present randomized controlled trial assessed the efficacy and safety of SAA in preventing RTI recurrence in patients with CKD.

Methods: Participants with CKD who had been diagnosed with RTI on more than 2 occasions in the preceding 12 months were enrolled between November 6, 2017, and August, 6, 2018. They were randomly assigned (1:1) to receive daily SAA combined with usual care (intervention) or usual care alone (control) for 24 months. The primary outcome was time to first RTI. Secondary outcomes were RTI rate, kidney function, proteinuria and serum immune indicators, detected by the clinical laboratory in the hospital. The study would be discontinued if the participant met the criteria of stopping the study. Kaplan-Meier method and multivariable Cox proportional hazards regression were used to compare the primary outcome between the two groups.

Results: Among the 540 patients screened, 114 participants were randomly assigned to the intervention group (n=57) or the control group (n=57). The median follow-up duration was 24.4 months. Compared with controls, participants in the intervention group did not have a significantly lower risk of RTI according to Kaplan-Meier analysis, but did have a significantly lower risk of RTI according to competing risk analysis (HR 0.65, 95% CI: 0.42-1.00; P=0.05), when considering endpoint (dialysis or death) and loss to follow-up as competing risks, and had a significantly lower rate of RTI [1.65 vs. 2.19 episodes per patient-year, respectively; incidence rate ratio (IRR) 0.75, 95% CI: 0.62-0.92; P=0.006]. Apart from lower study serum IgG levels in the intervention group at 24 months (mean difference 0.68 g/L; 95% CI: 0.07-1.29; P=0.029), all other secondary outcomes and overall adverse events were comparable between the 2 groups.

Conclusions: SAA is a promising effective and safe therapy for preventing RTI in patients with CKD. However, the efficacy of SAA in children and adolescents still needs further study.

Trial registration: Chinese Clinical Trials Registry identifier: ChiCTR-IOR-17012654.

Keywords: Chronic kidney disease prevention (CKD prevention); randomized controlled trial; respiratory tract infection (RTI); self-administered acupressure (SAA).