The Tongue Features Associated With Chronic Kidney Disease
The Tongue Features Associated With Chronic Kidney Disease
The Automatic Tongue Diagnosis System (ATDS) was developed to capture tongue images and
 extract features reliably to assist the diagnosis of TCM practitioners.This project will
 employ the ATDS verified to extract the tongue features of patients with chronic kidney
 disease(CKD) including dialysis patients. A TCM indices derived through the non-intrusive
 tongue diagnosis procedure can provide valuable information for clinical doctors to analyze
 the current status of a patient and dynamically schedule a treatment plan, facilitating early
 detection and diagnosis of CKD.
Chronic kidney disease (CKD) is an important global public health problem. According to
 related literatures, the prevalence of CKD is about 11% .CKD is a progressive disease. If it
 progresses to end-stage renal disease (ESRD), renal replacement therapy: dialysis and renal
 transplantation, is required to maintain life. The growing prevalence and progression of
 chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden
 to patients, caregivers, and society. The societal direct and indirect costs of CKD and
 end-stage renal disease are substantial and increase throughout disease progression. There is
 significant variability in the evidence about direct and indirect costs attributable to CKD
 and end-stage renal disease, with the most complete evidence concentrated on direct health
 care costs of patients with advanced to end-stage CKD.

 CKD, also called chronic kidney failure, is described as a sustained reduction in glomerular
 filtration rate or evidence of structural or functional kidney abnormalities.Chronic kidney
 disease (CKD) refers to all five stages of kidney damage, from very mild damage in stage 1 to
 complete kidney failure in stage 5. CKD symptoms include pain, itch(pruritus), peripheral
 numbness, sleep disturbances, depression, fatigue, nausea and vomiting. Factors that
 contribute to these symptoms include anaemia, uraemic toxins, reduced renal capacity, chronic
 disease-related inflammation, and psychological stress associated with long-term illness.If
 it progresses to end-stage renal disease (ESRD), renal replacement therapy, including
 hemodialysis, peritoneal dialysis and kidney transplantation, is required to maintain life.
 Therefore, it is essential to find effective and conservative treatment methods to delay the
 progression of CKD.

 Diagnosis in traditional Chinese medicine (TCM) is based on four procedures, observation,
 smelling or listening, inquiry, and palpation. Tongue diagnosis, serving as a vital
 non-invasive tool to provide useful clinical information, plays a pivotal role in TCM. The
 tongue is considered to reflect the physiological and pathological condition of the body, as
 well as the degree and progression of disease, through the meridians that connect the tongue
 to the internal organs.By observing tongue features, TCM practitioners can probe qi-blood,
 yin-yang disorders which are important in treatment selection and prognosis.Clinically,
 practitioners observe tongue characteristics, such as tongue color and shape, fur color and
 thickness, and the amount of saliva, to help deduce the primary pattern of a patient.
 However, tongue diagnosis is often biased by subjective judgment, which originates from
 personal experience, knowledge, diagnostic skills, thinking patterns, and color
 perception/interpretation.The inconsistency of subjective diagnosis can be improved by using
 the development of validated instruments. The automatic tongue diagnosis system (ATDS) has
 shown high consistency and can provide objective and reliable information and analysis of
 tongue features, facilitating doctors in making effective observations and diagnoses of
 specific diseases.Previous studies have been conducted on exploring the association between
 tongue characteristics and specific diseases, including rheumatoid arthritis,
 breastcancer,type 2 diabetes, metabolic syndrome, eczema, dysmenorrhea and functional
 dyspepsia, gastroesophageal reflux disease.However, to the best of our knowledge, no study
 has yet been performed on the comprehensive scrutiny of tongue features in patients with CKD
 using ATDS.

 The objectives of this protocol are to apply the noninvasive ATDS to evaluate tongue
 manifestations in patients with CKD, and to provide valuable information for clinical
 doctors, which can be used to facilitate the early detection and diagnosis of CKD, to analyze
 the current status of patients, and to dynamically schedule treatment plans.
Inclusion Criteria:

 -  age over 20 years old;

 -  CKD group:CKD stage 3-5 including dialysis patients

 -  Healthy group: without any medical history

 Exclusion Criteria:

 -  cancer;

 -  acute infection;

 -  unable to protrude the tongue stably;

 -  risk of temporomandibular joint dislocation.