Investigation on the status quo of acute kidney injury incidence in CCU patients and TCM syndromes analysis

Abstract

Objective To investigate the incidence of acute injury (AKI) in the coronary care unit (CCU) of the hospital of Chinese medicine and the characteristics of traditional Chinese medicine (TCM) syndromes. Methods A retrospective clinical study was performed in the patients admitted into the CCU of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from January 1, 2015 to December 31, 2015. The patients were divided into AKI group and non-AKI group according to the diagnosis criteria of AKI recommended by KDIGO guidelines. The two groups were compared in demographic data, clinical features, treatment, clinical outcome, and TCM symptoms. Multivariate logistic regression method was used to analyze risk factors of AKI. Results Total 186 cases were enrolled in this study, including 65 cases (34.5%) of AKI, and the rate of missed diagnosis was 89.2%. ①Demographic data and clinical features: The ages, multiple organ failure incidences, and levels of urea nitrogen and serum creatinine (Scr) were significantly higher in the AKI group than in the non-AKI group (P<0.001); The incidences of N-terminal pro-B-type natriuretic peptide (NT-BNP) increase, lower extremity edema, hypertension, and hyperuricemia were higher in the AKI group than in the non-AKI group (P<0.05). ②Treatment: The incidence of diuretics use was significantly higher in the AKI group than in the non-AKI group (χ2=17.729, P<0.001). ③Multivariate logistic regression analysis showed that the diuretics use (OR=6.980, CI 2.287-21.306), eGFR <90 ml/(min·1.73 m2) (OR=2.201, CI 1.076-4.504), and non-renal multiple organ failure (OR=3.733, CI 1.602-8.702) were the independent risk factors of AKI. ④Clinical outcomes: In the AKI group, the hospital mortality rate (χ2=16.510, P<0.001) and the Scr at discharge (Z=-7.683, P<0.001) were significantly higher than those in the non-AKI group. ⑤TCM syndromes: The incidence of water stagnation syndrome was higher in the AKI group than in the non-AKI group (χ2=0.024, P<0.05). Among the deficiency syndromes, the incidence of Qi deficiency syndrome was the highest, while the incidence of Yin deficiency syndrome the second highest. Among the excess syndromes, the incidence of blood stagnation syndrome was the highest, and the incidence of phlegm syndrome the second highest. The incidence of intermingled deficiency and excess (50.8%) was the highest among all syndromes in the AKI group. Conclusions The occurrence of AKI in the CCU of the hospital of Chinese medicine was featured with high incidence rate and high missed diagnosis rate. In clinical treatment, high-dose diuretics should be used with caution, emphasizing on the protection of kidneys and other vital organs. For TCM therapy, attention should be paid to simultaneous treatment of heart and kidney for both symptoms and root causes , with a focus on tonifying the Qi and nourishing the Yin, and activating the blood and dissolving the stasis, as well as excreting the water and eliminating the phlegm. Key words: Acute injury; Coronary care unit; TCM syndromes