Clinical Characteristics,Risk Factors And Prognosis Of Patients With Acute Kidney Injury Developing Cardiorenal Syndrome Type-3

ObjectiveTo explore the incidence,clinical characteristics,risk factors and prognosis of cardiorenal syndrome type 3(CRS3)in patients with acute kidney injury(AKI)in order to provide preventive strategies for CRS3 and improve the prognosis of patients with AKI.MethodA single center and retrospective case-control study was conducted for 186 patients with acute kidney injury(AKI)discharged from the PLA Army General Hospital during January 2013 and October 2016.The patients were divided into CRS 3 group(53cases)and non-CRS 3 group(133cases)according to whether secondary cardiac dysfunction occurred or not.Demographic data,clinical data,laboratory indexes and prognosis of the two groups were collected from the computerized hospital admissions and discharges database.We established a database by spss22.0 software,calculated the incidence of CRS3 in patients with AKI and analyzed the risk factors of CRS3,also observed the impact on prognosis of AKI.The main statistical methods included t-test,chi square test,single factor correlation analysis and multivariate logistic regression analysis.ResultInfectious diseases(36.02%)and nephrotoxic drugs(29.03%)were the two most common causes of AKI in CRS3.Out of 186 patients with AKI,53(28.49%)developed into CRS 3.Unstable angina pectoris(33.96%)were the most common complications.Univariate analysis showed that Age,body mass index(BMI),history of chronic kidney disease,etiology,AKI staging,D-dimmer,creatinine/urea nitrogen(SCr/BUN),estimated glomerular filtration rate(eGFR),high level of fibrinogen and cholesterol,left ventricular diastolic dysfunction,cardiac function classification?level 3,the use of hormones,diuretics,microcirculation-improving drugs and renal replacement therapy were different between the two groups.The multivariate regression analysis showed that age?60,history of chronic kidney disease,eGFR<60ml/min/1.73m~2,diastolic dysfunction of left ventricular and high level of cholesterol were independent risk factors for the incidence of CRS 3 in patients with AKI.The clinical use of microcirculation-improving drugs would be protective factors.The lenth of hospital stay,medical costs and in-hospital mortality of CRS3 group were significantly higher than those of the non-CRS 3 group.And CRS3together with age and vasoactive drugs were independent risk factors for mortality of patients with AKI.ConclusionThe incidence of CRS3 among patients with AKI lead to poor clinical prognosis,while increasing the patient's medical burden.The age,history of chronic kidney disease,eGFR<60ml/min/1.73m~2,high level of cholesterol and diastolic dysfunction of left ventricular were independent risk factors of CRS 3 in patients with AKI.The clinical use of microcirculation-improving drugs would be protective factors.Understanding the incidence and risk factors of CRS 3 might be useful for the early prevention of CRS3 and improving the prognosis of patients with AKI.