末期腎病變（ESRD）病人洗腎前中醫治療歷程

The Traditional Chinese Medicine Treatment Intervention Before Kidney Dialysis of End-Stage Renal Disease (ESRD) Patient

本文病患為72歲女性，有疲倦、泡沫尿及貧血的現象，59歲於西醫就診發現腎有萎縮情形和肌酸酐指數（Creatinine，Cre）偏高，診斷為慢性腎臟病（Chronic Kidney Disease，CKD），治療期間肌酸酐指數仍持續上升沒有緩和的跡象，至2018年5月時肌酸酐指數已高達9.2mg/dl，腎絲球過濾率（estimated Glomerular Filtration Rate，eGFR）僅剩4.47ml/min/1.73m2，確診為末期腎病變（End-Stage Renal Disease，ESRD），西醫強烈建議血液透析，但病人拒絕，故至本院中醫就診，之後定時於中醫與西醫就診，服藥近一年，無出現腎功能持續惡化以及無體重減輕或其他副作用，肌酸酐指數逐漸下降至7.8-8.5mg/dl範圍（腎絲球過濾率為5.39-4.63ml/min/1.73m2），期間還可出國旅遊，說明在中醫師的診治下服用符合藥品優良製造作業流程（Good Manufacturing Practice，GMP）的科學中藥不僅不會加劇損壞腎功能，更可以有效控制病情，維持ESRD病人僅剩的腎功能，推遲洗腎時間，使病人及家屬有更多時間可以清楚了解透析治療的優、缺點，並與腎臟科醫師討論治療的目標，建立良好的醫病關係與共識。

This case reports a 72-year-old woman with fatigue, foamy urine, and anemia. At the age of 59, she was found atrophic kidney and high Creatinine (Cre) value, diagnosed with chronic kidney disease (CKD) from nephrologists. During the treatment, the creatinine value continued to rise without easing. She was diagnosed ESRD in May 2018, the creatinine value had reached 9.2 mg/dl, and the estimated Glomerular Filtration Rate (eGFR) dropped to 4.47 ml/min/1.73m2. She saw a Chinese medicine doctor because she refused that western doctor strongly recommended hemodialysis. After that, she regularly consulted Chinese and Western medicine doctor. After taking the Chinese medicine for nearly a year, she could travel abroad during this period and did not appear continuous deterioration of kidney function, no weight loss and other side effects and the creatinine value gradually decreased to the range of 7.8-8.5 mg/dl (eGFR: 5.39- 4.63 ml/min/1.73m2). This explains that taking qualified Good Manufacturing Practice (GMP) scientific Chinese medicine under the diagnosis and treatment of a Chinese medicine doctor will not only unlikely exacerbate the damage to kidney function, but also effectively control the condition, maintain the remaining kidney function of ESRD patients, delay the hemodialysis time, and allow patients and their families more time clearly understand the advantages and disadvantages of hemodialysis treatment, discuss the goals of treatment with nephrologists, and establish a good relationship and consensus between doctors and patients.