| Objective: Large studies show that chronic kidney disease (CKD) is anindependent risk factor of cardiovascular disease (CVD).Compared withpatients with normal renal function, the morbidity of CVD is obviouslyincreased in those who have CKD, and with the progress of CKD the risk ofCVD remarkably increases, which seriously influence the prognosis of CVD.Therefore, early detecting of concomitant renal impairment, searching for therisk factors, intervening and controlling the risk factors can significantlyimprove the prognosis of patients with cardiovascular disease. There existsmany kidney injury risk factors, such as the disease itself, drug treatment,contrast agent, the condition change etc for patients hospitalized withcardiovascular disease. However clinical detecting effort of renal function isnot enough. Most clinicians only detect creatinine, rarely detect creatinineclearance rate, resulting that many patients with renal impairment cannot befound timely and given appropriate protection and treatment, which increasethe risk of cardiovascular disease. Therefore, it is vital to the prognosis ofpatients with cardiovascular disease through increasing detecting effort andearly detecting concomitant renal impairment. The aim of this study is todetermine the general condition of renal function at admission and thenecessity of creatinine clearance rate, observe the change of renal functionduring hospitalization and explore its influence factors, and finally underliningthe importance of renal function protection for patients hospitalized withcardiovascular disease.Methods:1、 Study objectives:317patients with cardiovascular disease hospitalized inthe second hospital of Hebei Medical University for more than a week whose data were complete were selected from March,2011to September,2011.2、 Study methods: General conditions including age、gender、hypertensionhistory、diagnosis etc were collected in all the patients at admission; Routinelaboratory analyses, including creatinine levels, were performed in all patients.The glomerular filtration rate (GFR) was estimated with the simplified MDRD(Modification of Diet in Renal Disease) formula, which is accepted as a validmethod for estimating glomerular filtration by K/DOQI guidelines; Detectingperformance of creatinine and creatinine clearance rate were compared in thisstudy; creatinine and creatinine clearance rate were detected at admission andbefore discharge from hospitalization for the patients hospitalized for morethan a week(13days of hospitalization on average), in order to identify thechange result of renal function and discuss the risk factors in patients withcardiovascular disease.By definition of creatinine, WRF occurred when the serum creatininelevel increased during hospitalization by26.5μmol/L (0.3mg/dL).By definition of creatinine clearance rate, WRF occurred when theclassification was dropped a notch during hospitalization by K/DOQIguidelines.creatinine clearance rate was calculated by simplified MDRD formula：Ccr=186.3(serum Cr)–1.154(age)–0.203(female:×0.742)。3、 Statistics analysis: All analyses were performed with statistical softwareSPSS13.0. Continuous variables are expressed as the arithmetic mean andstandard deviation (SD) or as the median and interquartile range, dependingon whether or not they showed a gaussian distribution. Continuous data withgaussian distribution were compared with the Student t test and those with anon-gaussian distribution, with the Wilcoxon ranksum test. Discrete variableswere expressed as percentage and compared with the X2test or Fisher test.Multivariate logistic regression analysis was used to identify risk factors ofrenal function. Statistical significance was accepted at a P value of <0.05.Results: 1、The general condition of renal function in patients with cardiovasculardisease at admission and comparison of detecting efforts between creatinineand creatinine clearance rate.Among the total population at admission,18(5.7%) cases presented renaldysfunction whose admission creatinine was＞136μmol/L according todomestic classified criteria for chronic renal insufficiency, among them,13cases(4.1%) mildly impaired renal function (<178μmol/L),5cases(1.6%)moderately impaired renal function(＞178μmol/L) and no cases severelyimpaired renal function(＞450μmol/L). According to the standard ofAmerican National Kidney Foundation K/DOQI guidelines,99cases(23.3%)presented renal dysfunction whose admission creatinine was <90ml/（min.1.73m2）,74cases(23.3%) mildly impaired renal function (60-89ml/min.1.73m2),23cases(7.3%) moderately impaired function(30-59ml/min.1.73m2), and2cases(0.6%) severely impaired function (15-29ml/min.1.73m2).The detecting effort of creatinine was inferior to that of creatinineclearance rate, and the result was statistically significant, p<0.05.2、The change result of renal function in patients with cardiovascular disease.By definition of WRFCERA,27cases (8.5%) experienced WRF; and bydefinition of WRFCCr,47(14.8%) cases experienced WRF. The rate of WRFdetected by creatinine clearance rate was superior to that detected bycreatinine. The difference was statistically significant, p<0.05.3、 General characteristics of patients with and without WRF duringhospitalizationThe total study population was divided to WRF group and no WRF groupaccording to definition of WRFCCr. After compare the general characteristicsbetween the two groups, we found that rates of WRF were differed betweenthe two groups with respect to age、admission creatinine、admission creatinineclearance rate、hypertension history、diabetic history、cardiac insufficiency、usage of antibiotics、large dose of diuretics、low dose of dopamine and CKDhistory. The difference was statistically significant（p<0.05） 4、The univariate analysis was used to analyze above variables, of which thedifference was statistically significant.On univariate analysis, old age(＞71)、high admission creatinine、lowadmission creatinine clearance rate、hypertension history、diabetic history、cardiac insufficiency、usage of antibiotics、large dose of diuretics and CKDhistory were associated with WRF. The difference was statistically significant.5、Multivariate analysis was used to identify the independent risk factors ofWRF in patients hospitalized with cardiovascular disease.On multivariate analysis, old age(＞71)、 low admission creatinineclearance rate、cardiac insufficiency、usage of antibiotics and CKD historywere independently associated with WRF. There OR values were2.85（95%CI:1.39~5.84）、2.05（0.91~4.63）、2.52（95%CI:1.19~5.34）、5.48（95%CI:1.39~21.6）、3.27（95%CI:1.56~6.84）respectively.Conclusions: This study showed that renal dysfunction in patients withcardiovascular disease was very common; detecting performance of creatinineclearance rate on renal function was superior to that of creatinine values androutine testing of creatinine clearance rate was necessary; there were manyrenal injury risk factors for patients with cardiovascular disease during theprocess of hospitalization. Therefore, clinicians should focus on these riskfactors and timely detect the change of renal function, in order to protect andreduce further kidney damage and promote long-term prognosis. |
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