ABSTRACT
Objective To evaluate the role of acute kidney injury (AKI) in predicting the early (30-day) and late (30-day to 5-year) mortality of acute myocardial infarction (AMI) patients during hospitalization.Methods A total of 1371 adult patients diagnosed with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively with collecting their relevant clinical data from the hospital's database.AKI was categorized according to the 2012 KDIGO AKI criteria.To compare between death group and non-death group in AMI patients during 30-day and 30-day to 5-year.Different AKI stages of patients were compared,and their all-cause mortality were analyzed by Kaplan-Meier.Using multivariate COX regression analysis with two models to assess the factors for AMI patients in 30-day to 5-year.Results The prevalence of AKI after AMI in death group was higher than that in non-death group (the 30-day prevalence was 72.7％ vs 27.4％,P ＜ 0.001;the 5-year prevalence was 36.3％ vs 26.2％,P=0.013).In both early (30-day) and late (30-day to 5-year) follow up,the KDIGO grading distribution of AKI was different between death group and non-death group (P ＜ 0.001 in 30-day follow up and P=0.002 in 30-day to 5-year follow up).Among the 1371 AMI patients,410 (29.9％) developed AKI during the hospital stay.The 30-day and 30-day to 5-year mortality rates were 5.6％ (77/1371) and 11.3％ (146/1294) respectively.All-cause mortality and cardiovascular mortality were significantly higher in patients with AKI-Ⅰ stage,AKI-Ⅱ stage and AKI-Ⅲ stage than those with non-AKI (all P ＜ 0.001),especially in patients with AKI-Ⅲ stage.Further stroke history (HR=3.122,P=0.012),AKI severity (AKI-Ⅰ stage HR=3.034,P=0.028;AKI-Ⅱ stage HR=7.832,P＜0.001;AKI-Ⅲ stage HR=9.919,P＜0.001),and β-blocker therapy (HR=0.591,P=0.040) were independent predictors of 30-day mortality,while aging (HR=1.061,P ＜ 0.001),albumin (HR=0.943,P=0.023),AKI-Ⅲ stage (HR=3.944,P=0.007),β-blocker therapy (HR=0.660,P=0.041) and percutaneous coronary intervention (HR=0.256,P ＜ 0.001) were independent predictors of 30-day to 5-year mortality.Both at early (30-day) and late (30-day to 5-year) follow-up,AKI with or without baseline renal dysfunction were independent predictors of death in patients with AMI (all P ＜ 0.05).Conclusions AKI strongly correlated with short-and long-term allcause mortality of AMI patients,regardless of the baseline renal impairment.Specifically,the more severe AKI,the higher short-term mortality AMI patients have.
ABSTRACT
Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI).Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively.AKI was defined according to the 2012 KDIGO AKI criteria.Based on the occurrence of AKI,the patients were divided into AKI group and non-AKI group.According to the AKI timing,the patients were divided into subgroups including conservative treatment groups,coronary angiography (CAG) groups and coronary artery bypass grafting (CABG) groups,respectively.Related risk factors of AKI were analyzed by univariate and multivariate logistic regression.Results Of the 1 371 patients,410(29.9％) developed AKI.Compared to the non-AKI group,in-hospital mortality increased significantly in the AKI group (17.1％ vs 3.9％,x2=68.0,P ＜ 0.001).Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049,95％ CI:1.246-3.370),increased fasting plasma glucose(FPG) (OR=1.070,95％CI:1.018-1.124),diuretics (OR=1.867,95％CI:1.220-2.856) and Killip class 4 status (OR=1.362,95％ CI:1.059-3.170) were all independent risk factors of AKI,while increased DBP on admission was a protective factor (OR=0.986,95％ CI:0.974-0.998) for the conservative management group.Decreased baseline eGFR (OR=2.371,95％CI:1.500-3.747),increased FPG(OR=1.009,95％CI:1.005-1.012),diuretics (OR=1.674,95％CI:1.042-2.690),intraoperative hypotension (OR=2.276,95％ CI:1.324-3.575) and acute infection (OR=1.678,95％CI:1.023-2.754) were independent risk factors of AKI for the CAG group.Decreased baseline eGFR (OR=2.246,95％CI:1.340-3.981),increased FPG (OR=1.059,95％CI:1.018-1.124),diuretics (OR=1.723,95％CI:1.122-2.650),and low cardiac output syndrome after operation (OR=2.331,95％ CI:1.277-3.286) were independent risk factors of AKI for CABG group.Conclusions AKI is a common complication and associated with increased mortality after AMI.Decreased baseline renal function,increased FPG and diuretics were common independent risk factors of AKI after AMI.
ABSTRACT
Objective To survey the epidemiology of chronic kidney disease (CKD) among elderly people in two districts of Jiangsu province, China. Methods A total of 1404 residents aged 60 years or older in Huaian and Suzhou city in Jiangsu province were randomly recruited from the community population. All the people were screened for albuminuria (increased morning spot urine albumin-to-creatinine ratio, UACR) and reduced renal function (decreased eGFR by simplified MDRD equation). Urinary creatinine and albumin, serum creatinine, uric acid, cholesterol,triglyceride, low density lipoprotein-cholesterol, high-density lipoprotein cholesterol and fasting blood (1.73 m2) -1] and/or albuminuria (UACR ≥30 mg/g). The associations between healthy characteristics and indicators of kidney damage were examined. Results A total of 1316 (93.7%) elderly people completed the study. The prevalence of CKD was 32.3% and the awareness rate was only 9.6%. Albuminuria and reduced renal function were found in 30.2% and 3.2% of subjects respectively. The Logistic regression model showed that age, gender, hypertension,hypercholesterinemia and hyperuricaemia were independently associated with CKD. Systolic blood pressure (SBP) of 140-159 mm Hg exhibited a lower adjusted OR value (0.675) for CKD, while SBP of 160-179 mm Hg and of at least 180 mm Hg exhibited higher adjusted OR values (1.330 and 1.146). Similarly, FBG of 5.6-6.9 mmol/L exhibited a lower adjusted OR value for CKD as compared to FBG of at least 7.0 mmol/L (0.628 vs 1.941). Conclusions The prevalence of CKD in elderly people of Jiangsu province is quite high. Age, gender, hypertension,hypercholesterinemia and hyperuricaemia are independent risk factors for the development of CKD.