Objective To explore the predictive value of coagulation markers combined with serum monocyte chemotaxis protein-1 (MCP-1) for acute kidney injury(AKI)in patients with chronic kidney disease(CKD). Methods A total of 155 CKD patients were admitted to our hospital from January 2021 to June 2023, among which 40 patients had AKI. Clinical data, coagulation indices and serum MCP-1 were compared between the 40 patients with AKI and the 115 CKD patients without AKI. The important risk factors for the presence of AKI and the value of coagulation indices combined with serum MCP-1 for the prediction of AKI in CKD patients was explored. Results Thrombin time (TT), activated partial thrombin time (APTT), prothrombin time(PT)and serum MCP-1 were higher in AKI group than in non-AKI group (t=20.506,20.551,21.120 and 16.230 respectively; P＜0.001); fibrinogen(FIB)was lower in AKI group than in non-AKI group (t=8.441,P＜0.001). The presence of AKI was not related to age, sex, body mass index (BMI) and diabetes mellitus (t=0.521, 0.760, 0.648 and 2.399 respectively; P=0.477, 0.383, 0.341 and 0.121 respectively), but was related to diastolic blood pressure, systolic blood pressure, serum uric acid, fasting blood glucose, total cholesterol(TC),serum creatinine(Scr), triglyceride(TAG), hyperlipidemia and hypertension (t=15.681, 12.942, 11.694, 6.914, 12.836, 8.392, 9.724, 14.856 and 11.372 respectively; P＜0.001). Multivariate logistic regression using the presence of AKI as the dependent variable and the factors with P values＜0.05 described above as the independent variables demonstrated that systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood uric acid, TC, TAG, Scr, hypertension, hyperlipidemia, PT, TT, FIB, APTT and MCP-1 were the main risk factors for AKI in CKD patients (OR value=3490, 3.357, 3.050, 2.980, 3.264, 2.861, 3.287, 2.939, 3.466, 9.196, 3.350, 3.281, 2.974 and 3.404 respectively; 95% CI： 2.210～4.770, 1.947～4.767, 1.862～4.238, 1.838～4.122, 2.104～4.424, 1.751～3.971, 2.065～4.510, 1.813～4.065, 2.416～4.516, 1.982～4.410, 2.082～4.618, 2.103～4.459, 1.780～4.168 and 2.092～4.716 respectively; P=0.002, 0.004, 0.005, 0.002, ＜0.001, ＜0.001, ＜0.001, 0.007, 0.002, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). Conclusion The levels of TT, APTT, PT, FIB and MCP-1 are related to the occurrence of AKI, and have the ability to predict the occurrence of AKI in CKD patients.
ZUO Jun-Qiu
,
LIU Xiu-Juan
. The value of coagulation index combined with serum MCP-1 in predicting acute kidney injury in patients with chronic kidney disease[J]. Chinese Journal of Blood Purification, 2024
, 23(04)
: 277
-281
.
DOI: 10.3969/j.issn.1671-4091.2024.04.008
[1]Yanai H, Adachi H, Hakoshima M, et al. Molecular Biological and Clinical Understanding of the Pathophysiology and Treatments of Hyperuricemia and Its Association with Metabolic Syndrome, Cardiovascular Diseases and Chronic Kidney Disease[J]. Int J Mol Sci,2021,22(17):9221.
[2]Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke[J]. J Cereb Blood Flow Metab,2019,39(10):1893-1905.
[3]Provenzano M, Coppolino G, Faga T, et al. Epidemiology of cardiovascular risk in chronic kidney disease patients: the real silent killer[J]. Rev Cardiovasc Med,2019,20(4):209-220.
[4]Waheed Y, Yang F, Sun D. Role of asymptomatic hyperuricemia in the progression of chronic kidney disease and cardiovascular disease[J]. Korean J Intern Med,2021,36(6):1281-1293.
[5]Xu Z, Zhang Y, Zhang C, et al. Clinical Features and Outcomes of COVID-19 Patients with Acute Kidney Injury and Acute Kidney Injury on Chronic Kidney Disease[J]. Aging Dis,2022,13(3):884-898.
[6]郭峻氚,陈东,郭仁楠,等. 血清MCP-1、TRAF-6水平在脓毒症严重程度和急性肾损伤评估的作用[J]. 新疆医科大学学报,2023,46(4):485-489.
[7]上海慢性肾脏病早发现及规范化诊治与示范项目专家组. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志,2017,37(1):28-34.
[8]Theofilis P, Vordoni A, Koukoulaki M, et al. Dyslipidemia in Chronic Kidney Disease: Contemporary Concepts and Future Therapeutic Perspectives[J]. Am J Nephrol,2021,52(9):693-701.
[9]Spence JD, Urquhart BL. Cerebrovascular Disease, Cardiovascular Disease, and Chronic Kidney Disease: Interplays and Influences[J]. Curr Neurol Neurosci Rep,2022,22(11):757-766.
[10]Vilay AM. Antibiotic Dosing in Chronic Kidney Disease and End-Stage Renal Disease: A Focus on Contemporary Challenges[J]. Adv Chronic Kidney Dis,2019,26(1):61-71.
[11]李晓玲,周文杰,邓伟,等. 凝血指标联合血清胱抑素C对脓毒症急性肾损伤患者预后的预测价值[J]. 实用医学杂志,2023,39(1):81-85.
[12]张霄,牛争平,冀兵,等. 连续性肾脏替代治疗对外伤后急性肾损伤患者的效果及对凝血功能及炎症介质的作用分析[J]. 中国药物与临床,2019,19(2):275-276.
[13]莫曼秋,潘玲,严官强,等. 凝血指标与脓毒症相关急性肾损伤患者全因死亡的相关性分析[J]. 中华肾脏病杂志,2019,35(10):758-764.
[14]陈桢,高丽萍. 慢性肾衰竭患者血清Cys C、β2-MG、MCP-1及ANGⅡ水平变化及临床意义[J]. 昆明医科大学学报,2021,42(2):130-136.
[15]赵红梅,阿斯,宋琳,等. AMI合并慢性肾功能不全急性肾损伤患者TNFR1、MCP-1、尿酸的表达及临床意义[J]. 中国煤炭工业医学杂志,2022,25(1):45-49.
[16]刘芳芳,张新峰,陈珊珊,等. 枸橼酸可改善脓毒症急性肾损伤肾脏替代治疗患者凝血功能和氧化应激指标[J]. 内科急危重症杂志,2022,28(3):234-237.
[17]王旨,王政通. 尿HO-1和血清HFABP、FGF-23水平对慢性肾脏病患者急性肾损伤的预测及发生的Logistic回归分析[J]. 中国中西医结合肾病杂志,2023,24(1):49-51.
[18]滑瑞雪,邹陆曦,吴雨,等. 基于血肌酐变化参考值的急性肾损伤诊断标准对慢性肾脏病患者急性肾损伤的诊断及慢性肾脏病进展、全因死亡风险的预测研究[J]. 临床肾脏病杂志,2022,22(12):999-1005.
[19]陈德珠,曾繁琨,钟建,等. 危重症脓毒症并发急性肾损伤进展至慢性肾脏病危险因素分析[J]. 天津医药,2021,49(2):165-168.
[20]贾丽芳,周培一,白文英. 慢性肾脏病患者经皮冠脉介入术后急性肾损伤预后及影响因素分析[J]. 中华肾病研究电子杂志,2021,10(3):133-137.
[21]罗卫红,李佳欣,蒋建平,等. 急性肾损伤进展至慢性肾脏病的临床特征和危险因素——前瞻性、观察性队列研究[J]. 中华肾脏病杂志,2020,36(8):625-630.
