| Research purposes In order to provide theoretical basis for the prevention and treatment of ADPKD,we investigated the clinical characteristics of patients with autosomal dominant polycystic kidney disease(ADPKD),especially those with type 2 diabetes mellitus(T2DM),analyzed the causes of hospitalization and the risk factors for renal cyst infection in patients with ADPKD.Methods1.The basic information and clinical data of 505 patients with ADPKD hospitalized in our center from January 2009 to December 2021 were collected.Through retrospective analysis,the differences of clinical features between different genders,with and without T2 DM were compared,and the clinical characteristics of ADPKD and patients with T2 DM were summarized.2.The causes of hospitalization and their distribution in different genders,ages and time periods of 505 patients with ADPKD were analyzed retrospectively.3.A total of 411 patients with ADPKD hospitalized at our center without renal replacement therapy from January 2009 to December 2021 were included in this study.With the history of renal cyst infection as the dependent variable,there were 37 candidate independent variables,mainly including the general condition,other disease history and various laboratory indicators of the patients.The risk factors of renal cyst infection in ADPKD were analyzed by univariate and multifactorial logistic regression analysis.Results1.Among 505 hospitalized patients,264(52.3%)were male and 241(47.7%)were female.The mean age of hospitalization was 51.1±11.3 years old,and the age of first diagnosis of ADPKD was 36.0(6.0,29.0)years old,among which 55.6% of the patients were diagnosed with ADPKD through physical examination.Renal dysfunction and hypertension were the most common clinical manifestations of ADPKD,accounting for 85.0% and 84.2%,respectively.Gross hematuria,proteinuria,renal dysfunction and hyperlipidemia were more common in males(p<0.05),while renal cyst infection and polycystic liver were more common in females(p<0.05).Hypertension,lumbar and abdominal pain,renal cyst infection,albuminuria,renal dysfunction,and ESRD occurred earlier in males than in females(p<0.05).Compared with the normal values of each index,the levels of SCr,BUN,Cys-C,PTH and 24-hour urinary protein were significantly higher,while the levels of Alb and HDL-C were significantly lower.In the comparison of genders,WBC,Hb,ALT,SCr,UA,K,CEA,ferritin and 24-hour urinary protein in male patients were significantly higher than those in female patients(p<0.05),while TC,HDL-C and CA125 were significantly lower than those in female patients(p<0.05).2.There were 60 patients with T2 DM among the 505 ADPKD patients,accounting for 11.9%.The mean age of hospitalization was 56.0±10.0 years old,which was significantly older than that of patients without T2DM(p<0.001).Compared with patients without T2 DM,patients with T2 DM had significantly higher body weight and BMI(p<0.001),and ADPKD was diagnosed at a later age of 40.5(18.0,31.0)years old(p=0.001).There were also some differences in the incidence of complications between the two groups.The incidence of hypertension and hyperlipidemia in patients with T2 DM was significantly higher than those without T2 DM,while the incidence of polycystic liver was significantly lower(p<0.05).There was no significant difference in the onset age of most complications between the two groups(p>0.05).In the comparison of laboratory test indexes,it was found that WBC,N,FBG,TG and Hb A1 c were significantly higher(p<0.05),HDL-C was significantly lower(p<0.05)in patients with T2 DM.3.In 505 ADPKD patients,the most common cause of hospitalization was proposed renal replacement therapy(26.3%),followed by planned hepatic/renal cyst puncture(19.2%),gross hematuria(15.0%),renal cyst infection(11.7%),systematic physical examination(10.9%),dialysis-related problems(8.9%),others(4.0%),poorly controlled hypertension(2.2%),and albuminuria(1.8%).There were differences in the reasons for hospitalization between genders.Hospitalization for gross hematuria and poorly controlled hypertension were more common in males than in females(p<0.05),while hospitalization for liver/kidney cyst puncture and kidney cyst infection were more common in females than in males(p<0.05).The reasons for hospitalization of patients in different age groups were also different.There were statistically significant differences in gross hematuria and dialysis-related problems in each age group(p<0.05).The reasons for hospitalization also varied at different time periods.Among them,the proportion of patients with renal cyst infection and other reasons for hospitalization showed significant changes with the change of years(p<0.05).Regardless of gender,age or time period,proposed renal replacement therapy was the most important reason for hospitalization.In addition,the proportion of patients admitted to hospital for cyst puncture decreased slightly from 2018 to 2021 compared to 2009 to 2012,while the overall proportion of patients admitted to hospital for poor controlled hypertension was relatively low and did not change significantly with the change of time.4.There were 411 patients with ADPKD,including 329 patients without history of renal cyst infection and 82 patients with history of renal cyst infection.Univariate and multivariate logistic regression analysis of patients’ s data finally revealed that the history of lumbar and abdominal pain(OR=10.202,95% CI:3.102-33.555),the history of gross hematuria(OR=2.525,95% CI:1.263-5.048),and elevated FBG(OR=1.242,95% CI:1.02-1.513)were risk factors for ADPKD complicated with renal cyst infection(p<0.05),and the history of proteinuria(OR=1.781,95% CI:0.807-3.929)might also be a risk factor for ADPKD complicated with renal cyst infection(p>0.05).Conclusion1.By collecting the clinical data of a large single-center sample of ADPKD patients,this study summarized the clinical characteristics of Chinese ADPKD patients,and found that the clinical characteristics were different between genders and between patients with and without T2 DM.The incidence of most complications in male patients was higher than that in female patients,and the onset time was earlier than that in female patients.Compared with patients without T2 DM,the incidence of complications was higher in patients with T2 DM,but the onset age of most complications was not statistically different between the two groups.These results not only further improve the awareness of health care workers and patients on this disease,but also emphasize the importance of risk management of male patients and abnormal glucose metabolism.2.The causes of hospitalization were mainly related to the occurrence and development of complications that occurred repeatedly,solved difficultly in the outpatient clinic and affecting the prognosis.The causes of hospitalization also varied with gender,age and time period.In the past decade,the prevention and treatment of different complications in patients with ADPKD had made great progress,such as complex cyst outpatient development and hypertension management.Regardless of gender,age or time period,proposed renal replacement therapy was the most important reason for hospitalization,so delaying the progression of renal function in patients is still the target of clinical attention in the future.3.Through univariate and multivariate logistic regression analysis,it was found that the history of lumbar and abdominal pain,gross hematuria,and elevated FBG were risk factors for ADPKD complicated with renal cyst infection,which had clinical guiding significance for the early monitoring and prevention of renal cyst infection. |
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