Study On Risk Factors Of Hospitalized Patients With CKD4

ObjectiveData on risk factors of renal replacement therapy(RRT)in hospitaliz ed patients with CKD4 may help nephrologists to delay dialysis.The prese nt study aimed to evaluate whether physical,Traditional Chinese Medicin e(TCM)symptom,biochemical,and echocardiographic parameters are associ ated with the progression to renal replacement therapy(RRT)in early CKD 4 inpatients.MethodsA survival analysis was used in this study.Medical records of CKD4 inpatients in Guangdong Provincial Hospital of Chinese Medicine during January,2010-January,2020 were collected.Eligible cases were included according to the inclusion and exclusion criteria of the study.The related baseline indicators such as demography characteristics,TCM syndromes,laboratory test results,comorbidities and primary diseases were collected.The patients were followed up till they reached clinical outcomes(RRT)or the end of the study(January,2020).Survival analysis was used to compare the survival time of CKD4 patients.The Kaplan-meier survival curve was used to calculate the renal cumulative survival rate of the patients,and the Log-rank test was used to compare the groups.Results1.222 CKD4 inpatients were included in this study.The median age was 60.000(47.750-72.250)years.124 cases were female,accounting for 55.9%.The median fol low-up time was 2.410(1.324-4.272)years.199 inpatients(10.6%)received RRT,among those patients,the median time progression to RRT was 2.100(1.200-3.580)years.2.Those patients were divided into two groups according to whether progressed to RRT within 2.41 years.Those received RRT within 2.41 years had heavier urine protein,urine occult blood and account for a higher proportion of inpatients with diabetes mellitus(63.6%),chronic heart failure(43.6%),diabetic kidney disease(55.5%),damp syndrome(30.9%)and a less proportion of damp-heat syndrome(28.1%),hypertensive nephropathy(6.4%),obstructive nephropathy(0.9%).Their serum albumin and ejection fraction(EF)were lower(P<0.001).3.Cox regression univariate analysis found that age,damp syndrome,h ypertension,diabetic nephropathy,obstructive nephropathy,diabetes mell itus,hyperlipidemia,chronic heart failure,urinary protein,urine occu It blood,serum albumin,left ventricular mass index(LVMI),left ventricul ar end diastolic diameter,left ventricular end systolic diameter and eje ction fraction(EF)are closely related with the endpoint of CKD4.16 var iables were eventually entered into multivariable analysis.Cox regressio n multivariable analysis showed that age[hazard ration(HR):0.986;95%con fifidence interval(CI)(0.976-0.995);P=0.004],diabetic nephropathy[HR:1.75,95%CI:(.1.26-2.42),P=0.001],urinary protein[HR:1.149,95%CI:1.094-1.206),P<0.001],serum albumin[HR:0.974,95%CI:(0.952-0.996),P=0.022],LVMI[HR:1.010,95%CI:(1.004-1.016),P=0.002],left ventricular end systolic dia meter[HR:0.948,95%CI:(0.910-0.986),P=0.08]and ejection fraction[HR:0.970,95%CI:(0.950-0.990),P=0.004]were independently associated with factors fo r progression to RRT in CKD4 patients.ConclusionDKD,urinary protein,LVMI were risk factors that were significantly a ssociated with CKD progression to RRT in inpatients.Whereas,serum album in,LVDs,and EF are protective.The urinary protein,serum albumin and echocardiographic parameters need to be taken seriously.