Analysis Of The Relationship Between Dipstick Proteinuria, Chronic Kidney Disease And Coronary Heart Disease

Objective:To study the associations between dipstick proteinuria,Chronic Kideny Disease(CKD) and clinical characteristics and in-hospital mortality of the patients with coronary heart disease(CHD).Methods:3118 subjects with CHD enrolled the study from the department of cardiology in the Sencond Hospital of Tianjin Medical University from Jan 2005 to Dec 2007 including the physical examination,laboratory examination,ultrasound cardiography,urine examination,drug therapy and in-hospital mortality,then divided albuminuria of patients into:a:normal albuminuria;b:microalbuminuria;c: macroalbuminuria.The patients were also divided by the degree of dipstick proteinuria into patients without proteinuria,patients with proteinuria(+-),patients with proteinuria(1+),patients with proteinuria(2+) and patients with proteinuria(3+), all of whom were further divided into patients with or without CKD.Results:1.The albuminuria and macroalbuminuria groups had significantly higher estimated glomerular filtration rate(eGFR) level and lower left ventricular diastolic diameter than the normalalbuminuria group.The incidence of typeⅡdiabetes mellitus(DM)(80.3%) in the macroalbuminuria group is much higher than the normalalbuminuria group(46.2%)(P＜0.05).2.The levels of blood urea nitrogen, serum creatine,left ventricular mass(LVM) and left atrial diameter of the patients with CKD and proteinuria were the highest while the levels of red blood cell, hemoglobin,serum albumin and eGFR were the lowest in all the patients.For the patients without proteinuria,the CKD patients had higher in-hospital mortality(2.9%) than those without CKD(1.5%)(P＜0.05) and the level of ejection fraction(EF) of the patients without CKD was the highest while the ratios of decreased HDL(36.6%, P＝0.000) and systolic heart failure(8.1%,P＝0.000) were the lowest in all the patients. 3.In the patients with DM,the ratios of dilated left atrial diameter of all the patients with proteinuria were much higher than the patients without CKD or proteinuria.For the patients without proteinuria,the CKD patients had higher in-hospital mortality than those without CKD.In all the patients with hypertension,the ratio of decreased HDL of the patients with CKD and proteinuria was the highest(63.8%,P＝0.001) while the ratio of dilated left atrial diameter of the patents without CKD or proteinuria was the lowest(24.4%,P=0.000).In all the patients with hypertension and DM,the ratios of stroke,peripheral arterial disease,drinking and anemia were much higher than CKD patients without proteinuria.The ratio of atrial fibrillation in CKD patients without proteinuria(24.3%) was also much higher than the patients without CKD or proteinuria(9.9%)(P＜0.01).4.For the CKD patients,the percentage of DM, hypertension,periperal arterial disease,increased systolic blood pressure and dialostic blood pressure,anemia,hypoproteinemia,increased cholestoral and low density lipoprotein in the patients with proteinuria(3+) were much higher than those without proteinuria as well as the in-hospital motality of the patients with proteinuria(1+) and (+-).For the patients without CKD,all the patients with proteinuria had higher in-hospital mortality than the patients without proteinuria and the mortality increased with the increasing degree of proteinuria.5.Proteinuria correlated with eGFR,EF, hemoglobin and serum albumin negatively while it correlated with systolic blood pressure,heart rate,left atrial diameter,DM and progression of DM positively. Proteinuria was not the indenpendent risk factor for in-hospital mortality of CHD.Conclusion:Miacroalbuminuria performed as a high risk factor of CHD.The clinical characteristics of the patients with CKD were worse for the prognosis than the patients without CKD as well as patients with dipstick proteinuria,independent of the existence of DM and/or hypertension.Patients combined with dipstick proteinuria and CKD had the worst characteristics,especially for those with proteinuria(3+). Both the patients with proteinuria(+-) and proteinuria(1+) had higher in-hospital mortality than the patients without proteinuria.Proteinuria correlated with creatine clearance,ejection fraction,hemoglobin and serum albumin negatively while it correlated with systolic blood pressure,heart rate,atrial diameter,DM and progression of DM positively.Proteinuria was not the indenpendent risk factor for in-hospital mortality of patients with CHD.The intensive medication therapy to ameliorate proteinuria should be considered as a treatment for better prognosis.