The Risk Factors And Prognostic Analysis Of Major Adverse Cardiovascular Events In Patients With Stage 5 Chronic Kidney Disease

Objective: To explore the risk factors and survival prognosis of major adverse cardiovascular events(MACE)in patients with stage 5 chronic kidney disease.Methods: We used a retrospective cohort study.Collect the medical records of the patients with stage 5 chronic kidney disease who were hospitalized in the Department of Nephrology in the First Affiliated Hospital of Chongqing Medical University from January 2016 to January2019,including general conditions,underlying diseases,laboratory and imaging indexes.Patients were followed up by the medical record system,outpatient department,and telephone interview.The follow-up date ended in August 1st 2020 when the median follow-up time was 34(25,47)months.According to whether major adverse cardiovascular events occurred during the follow-up period,they were divided into 78 cases in MACE group and 228 cases in non-MACE group.Logistic multivariate regression analysis was used to analyze the risk factors of major cardiovascular adverse events,Kaplan-Meier survival analysis and Log Rank test were used to estimate the prognosis and the significance of the difference,and then the Cox risk regression model was used to analyze the impact of multiple factors on the prognosis,evaluate the degree of association between Chronic kidney disease(CKD)and the occurrence of major cardiovascular adverse events and all-cause death after adjusting for confounding factors.Results: A total of 394 CKD5 patients who met the inclusion and exclusion criteria were included,of which 88 cases(22.3%)were lost to follow-up.During the 34-month median follow-up period,58 people(19.0%)died and 78 people(25.5%)occurred major adverse cardiovascular events.According to whether MACE occurred or not,the results showed that compared with the non-MACE group,the MACE group showed a higher age,a higher proportion of hypertension,diabetes comorbidities,and a higher hs-CRP level.The difference was statistically significant(P<0.05).Binary logistic regression analysis showed: advanced age(OR=1.034,95%CI: 1.002～1.066,P=0.034),combined diabetes(OR=0.365,95%CI: 0.170～0.786,P=0.010),high Cys C level(OR=1.662,95%CI: 1.133～2.438,P=0.009)are in dependent risk factors for major adverse cardiovascular events in patients with CKD in the terminal stage(P<0.05).COX multivariate regression analysis showed: elder age(HR=1.070,95%CI: 1.041 ～ 1.101,P=0.000),high BMI(HR=0.895,95%CI: 0.820 ～ 0.977,P=0.013),lower albumin(HR =0.950,95%CI:0.902 ～ 1.000,P=0.048)is an independent risk factor for all-cause death in CKD patients.Conclusions: 1.The incidence of major adverse cardiovascular events in CKD5 patients is high.Most of them is stroke accounting for 33.3%,followed by congestive heart failure,which accounts for 28.2%.2.Old age,diabetes,and high Cys C levels are independent risk factors for major adverse cardiovascular events in patients with end-stage chronic kidney disease.3.Chronic kidney disease patients with MACE often have a poor prognosis and significantly short survival time.Among them,elder age,high body mass index,and lower albumin level are independent risk factors for death in CKD patients.