Analysis Of Risk Factors And Prognosis Of Acute Renal Injury In Stage 3-4 Of Chronic Kidney Disease

Objective:To explore the risk factors and basic disease composition of patients with A-on-C(stage 3-4),to provide a reference basis for predicting and reducing the occurrence of A-on-C(stage 3-4),and to explore the prognosis and prognostic factors of patients with A-on-C(stage 3-4),To provide help for delaying the progression of chronic kidney disease..Methods:The basic information of 254 patients with stage 3-4 chronic basic kidney diseases hospitalized in the second Department of the first Hospital of Jilin University from January 2015 to December 2018 were collected and analyzed retrospectively(Age,sex,nationality,days of hospitalization),composition of basic kidney disease,concomitant disease,inducing factors,past history,admission signs,laboratory data,pathological and imaging data,treatment measures,follow-up data and other clinical data.According to the occurrence of acute kidney injury,the patients were divided into A-on-C group and CKD group,and statistical analysis was made by software SPSS21.0.Counting data is expressed as a rate(composition ratio),and Pearson chi-square,continuity correction or Fisher exact probability method was used for comparison between the two groups.The measurement data was tested for normality by the Shapiro-Wilk method,the data conforming to the normal distribution was represented by the mean± standard deviation((?)),and the independent sample t test was used for comparison between the two groups;The data that don’t conform to the normal distribution are represented by the median(quartile),and the Mann-Whitney U test is used for the comparison between the two groups.The variables with statistical differences were analyzed by binary multivariate Logistic stepwise regression analysis to identify the independent risk factors for A-on-C(stage 3-4),and calculate the odds ratio((OR))and 95%confidence interval.For the selected continuous independent risk factors,draw the receiver operating characteristic(ROC)curve and calculate the area under the curve(ROC),sensitivity,specificity and Youden index.The cutoff value is the value of the maximum time variable of the Youden index.The variables with statistical differences were analyzed by multivariate Cox stepwise regression for independent risk factors related to long-term renal prognosis in patients with A-on-C(stage 3-4),and Kaplan-Meier method was used to draw the survival curve.Log-rank test was used for comparison between the two groups.P value less than 0.05 suggested the difference is statistically significant.Results:(1)A total of 254 patients with stage 3-4 chronic kidney disease were included in the study,92 patients(36.2%)in the A-on-C group and 162 patients(63.8%)in the CKD group.The results showed that the basic chronic kidney disease in A-on-C group was mainly composed of diabetic nephropathy,hypertensive nephropathy and lupus nephritis.The top three common inducing factors in A-on-C group were infection,aggravation of primary disease and use of nephrotoxic drugs.Compared with CKD group,the levels of albumin(ALB),basal glomerular filtration rate(eGFR),hemoglobin(Hb),calcium(Ca)and carbon dioxide binding capacity(CO2CP)in A-on-C group were lower(P<0.05),Urea nitrogen(BUN),uric acid(UA),cystatin C(CysC),urinary total protein quantification(U-TP),white blood cells(WBC),phosphorus(P),potassium(K),triglycerides(TG),cholesterol(TC)levels are higher(P<0.05),hospitalization period is longer(P<0.001),The proportion of proton pump inhibitors and diuretics used during the course of the disease was higher(P=0.001),and it was more likely to be complicated with infection(P=0.001).(2)Taking the factors with statistical differences in univariate analysis as independent variables and the occurrence of AKI as dependent variables,the results of multi-factor Logistic stepwise regression analysis showed that:Infection(OR=2.251,P=0.016),basal glomerular filtration rate(OR=0.958,P=0.044),albumin(OR=0.93 6,P=0.029),uric acid(OR=1.005,P<0.001),cystatinC(OR=1.961,P=0.006)and proton pump inhibitor history(OR=2.184,P=0.035)were statistically significant,which were independent risk factors for A-on-C(stage 3-4).To study the performance of the predictors,the above statistically significant continuous variables were used to draw the receiver operating characteristic(ROC)curve.The results showed that the AUC value of the combined diagnosis of the above indicators was 0.759,the sensitivity was 82.7%,the specificity was 60.9%,and the Youden index was 0.436.(3)A total of 254 patients were included in this study.The end point of follow-up was December 30,2020,the time to reach creatinine doubling or end-stage renal disease,and the end event was renal outcome(end-stage renal disease or creatinine doubling).At the end of follow-up,the average follow-up time(month)was 32.6±16.9 in the A-on-C group and 38.1±15.4 in the CKD group.Kaplan-Meier method was used for survival curve and Log-rank test was performed.Survival analysis showed that the renal survival curve(end-stage renal disease or creatinine doubling)in the A-on-C group was significantly lower than that in the CKD group alone(χ2=9.365,P=0.002),The 5-year cumulative survival rate of the A-on-C group was 48.9%.The CKD group was 72.3%,indicating that the long-term renal prognosis of patients with A-on-C(stage 3-4)may be worse than that of patients with stage 3-4 chronic kidney disease.(4)By single factor analysis was statistically significant kidney prognostic indicators as independent variables,renal outcome as state variables,follow-up time press in computation,line multiariable Cox regression analysis results showed that the basis of eGFR(HR=0.799,P=0.003),U-TP(HR=1.075,P=0.001),Hb(OR=0.969,P=0.012),those may be the main risk factors influencing the incidence of long-term renal outcomes in patients with A-on-C(stage 3-4).Conclusion:(1)In patients with A-on-C(stage 3-4),diabetic nephropathy,hypertensive nephropathy and lupus nephritis are more common,and infection is the most common inducing factor of A-on-C(stage 3-4).(2)Infection,basal eGFR,ALB,UA,CysC and PPI application history were independent risk factors for A-on-C.Among them,the higher the basic eGFR and ALB,the less likely the concurrent of AKI;monitoring the changes of the above-mentioned indexes and timely intervention during the hospitalization of patients with stage 3-4 chronic kidney disease are helpful to prevent the occurrence of AKI.(3)Combined prediction of A-on-C(stage 3-4)by basal eGFR,ALB,UA and CysC was more accurate than single factor prediction.(4)Compared with CKD(stage 3-4)patients,A-on-C(stage 3-4)patients had lower long-term renal cumulative survival rate and survival curve,and poor prognosis.Basal eGFR,U-TP,and Hb may be independent risk factors for long-term renal prognosis in A-on-C(stage 3-4)patients.Among them,the higher the level of Hb and basal eGFR,the lower the risk of creatinine doubling or ESRD in patients with A-on-C(stage 3-4).