International urology and nephrology · 2026
Association of governor vessel fire dragon moxibustion with patient-reported sleep quality and proteinuria in early stage diabetic kidney disease: a propensity score-matched retrospective cohort study.
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Mao Liuyan, Wen Xiaoyou, Zou Zixuan
Аннотация
BACKGROUND: Diabetic kidney disease (DKD) and comorbid insomnia form a pernicious bidirectional cycle that accelerates renal decline. Despite optimal guideline-directed medical therapy (GDMT), a substantial residual risk of proteinuria persists. This study aimed to examine the association of adjunctive Governor Vessel fire dragon moxibustion with patient-reported sleep quality, renal parameters, and documented safety outcomes in patients with early stage DKD, comorbid insomnia, and Spleen and Kidney Yang Deficiency.
METHODS: In this retrospective cohort study, 286 eligible patients were initially enrolled to receive either standard GDMT alone or GDMT combined with a 4-week course of fire dragon moxibustion. To reduce measured baseline confounding, 1:1 propensity score matching (PSM) was conducted, generating 82 well-balanced patient pairs (N = 164). The primary outcome was the change in the patient-reported Pittsburgh Sleep Quality Index (PSQI) global score. Exploratory secondary outcomes included 4-week changes in 24-h urinary protein (24 h-Upro), urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and fasting plasma glucose (FPG).
RESULTS: In the matched cohort, the moxibustion group achieved a significantly greater mean reduction in the global PSQI score than the standard care group (- 5.3 ± 1.8 vs. - 1.3 ± 1.1; P < 0.001), indicating a greater improvement in patient-reported sleep quality. Exploratory analyses showed greater 4-week reductions in 24 h-Upro (- 0.07 ± 0.06 vs. - 0.02 ± 0.05 g/24 h; P < 0.001) and UACR (- 23.9 ± 15.4 vs. - 5.8 ± 12.5 mg/g; P < 0.001). Changes in eGFR and FPG did not differ significantly between the two groups (both P > 0.05). Three patients (3.7%) experienced mild, transient localized skin reactions, and no severe adverse events were recorded.
CONCLUSION: Adjunctive Governor Vessel fire dragon moxibustion was associated with greater 4-week improvement in patient-reported sleep quality among patients with early stage DKD and insomnia and was generally well tolerated. Exploratory analyses also showed greater short-term reductions in 24-h urinary protein excretion and albuminuria, but their stabilization, durability, and long-term renal significance remain uncertain. Because treatment was not blinded and sleep quality was assessed using the self-reported PSQI, these findings should be interpreted cautiously and confirmed in prospective studies incorporating an appropriate sham or attention-matched control, objective sleep measures, repeated urinary measurements, and longer renal follow-up.
METHODS: In this retrospective cohort study, 286 eligible patients were initially enrolled to receive either standard GDMT alone or GDMT combined with a 4-week course of fire dragon moxibustion. To reduce measured baseline confounding, 1:1 propensity score matching (PSM) was conducted, generating 82 well-balanced patient pairs (N = 164). The primary outcome was the change in the patient-reported Pittsburgh Sleep Quality Index (PSQI) global score. Exploratory secondary outcomes included 4-week changes in 24-h urinary protein (24 h-Upro), urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and fasting plasma glucose (FPG).
RESULTS: In the matched cohort, the moxibustion group achieved a significantly greater mean reduction in the global PSQI score than the standard care group (- 5.3 ± 1.8 vs. - 1.3 ± 1.1; P < 0.001), indicating a greater improvement in patient-reported sleep quality. Exploratory analyses showed greater 4-week reductions in 24 h-Upro (- 0.07 ± 0.06 vs. - 0.02 ± 0.05 g/24 h; P < 0.001) and UACR (- 23.9 ± 15.4 vs. - 5.8 ± 12.5 mg/g; P < 0.001). Changes in eGFR and FPG did not differ significantly between the two groups (both P > 0.05). Three patients (3.7%) experienced mild, transient localized skin reactions, and no severe adverse events were recorded.
CONCLUSION: Adjunctive Governor Vessel fire dragon moxibustion was associated with greater 4-week improvement in patient-reported sleep quality among patients with early stage DKD and insomnia and was generally well tolerated. Exploratory analyses also showed greater short-term reductions in 24-h urinary protein excretion and albuminuria, but their stabilization, durability, and long-term renal significance remain uncertain. Because treatment was not blinded and sleep quality was assessed using the self-reported PSQI, these findings should be interpreted cautiously and confirmed in prospective studies incorporating an appropriate sham or attention-matched control, objective sleep measures, repeated urinary measurements, and longer renal follow-up.