Efficacy And Safety Evaluation Of Recombinant Human Brain Natriuretic Peptide For Injection In Patients With Chronic Kidney Disease Stage 3 To 5 Combined With Heart Failure

Objective:To observe the efficacy and safety of recombinant human brain natriuretic peptide for injection in the treatment of patients with chronic kidney disease stage 3 to 5with heart failure.Methods:Review September 2019 to December 2020 in the Department of Nephrology and Cardiology of the Affiliated Hospital of China Medical University that meet the criteria for chronic kidney disease stage 3 to 5 with heart failure,and remove those exclusion criteria,cardiac function grade III-IV l(NYHA classification),65 patients(38males and 27 females)were included in.After admission,collect the patient’s general data and baseline indicators and cardiac function classification(NYHA classification).Based on standard anti-heart failure treatments,including diuresis,cardiotonic,coronary expansion,active treatment of the primary disease,etc.,plus recombinant human brain natriuretic peptide for injection:50 ml of normal saline plus 0.5 mg of recombinant human brain natriuretic peptide for injection,First give a slow intravenous bolus with a load of 1.5ug/kg(half or full load can be used according to the patient’s blood pressure),then continue to pump intravenously at a rate of 0.0075ug/kg/min;if necessary,direct intravenous infusion without load dose.The course of treatment is 3-7 days.Record the patient’s cardiac function classification,NT-proBNP,heart rate(HR),blood pressure(BP),respiratory rate(RR),urea nitrogen(BUN),serum creatinine(SCr),and cystatin C(Cys-C),estimate the glomerular filtration rate(eGFR),electrolyte(K~+,Na~+)and other indicators after treatment.The database was established with Excel software,and the SPSS22.0 software system was used for statistical analysis.P<0.05 indicated that the difference was statistically significant.Result:1.After treatment,the cardiac function of the patients was significantly improved compared to before:before treatment,there were 4 cases of cardiac function grade III,61cases of cardiac function grade IV;after treatment,there were 48 cases of cardiac function grade IV→III,and 1 case of cardiac function grade III→II,the effective rate was as high as 75.38%.2.The patients’NT-proBNP,c Tn I,HR,BP,RR decreased after treatment:NT-proBNP before treatment:(20158.69±12964.62)pg/m L,after treatment NT-proBNP:(15861.53±12910.64)pg/m L,the difference is statistically significant(P=0.000);HR before treatment:(84±21)times/min,HR after treatment:(74±13)times/min,the difference is statistically significant(P=0.000);systolic blood pressure(SBP)before treatment:(146±28)mm Hg,after treatment SBP:(129±18)mm Hg,the difference is statistically significant compared with before treatment(P=0.000);pre-treatment diastolic blood pressure(DBP):(83±15)mm Hg,DBP after treatment:(62±7)mm Hg,the difference was statistically significant(P=0.000);diastolic blood pressure RR before treatment:(24±6)times/min,RR after treatment:(18±3)times/minute,the difference is statistically significant(P=0.000).3.After treatment,the BUN,SCr and Cys-C of the patient decreased,eGFR increased,and K~+and Na~+decreased:BUN before treatment:(21.95±11.57)mmol/L,BUN after treatment:(18.36±9.77)mmol/L,the difference was statistically significant(P=0.000);SCr before treatment:(373.45±257.09)umol/L,SCr after treatment:(333.81±218.12)umol/L,the difference is statistically significant(P=0.003);Cys-C before treatment:(3.41±1.31)mmol/L,Cys-C after treatment:(3.20±1.22)umol/L,the difference is statistically significant(P=0.001);eGFR before treatment:(20.63±15.23)ml/(min·1.73m~2),eGFR after treatment(23.78±18.12)ml/(min·1.73m~2),the difference is statistically significant(P=0.001);K~+before treatment:(4.56±0.75)mmol/L,K~+(4.04±0.55)mmol/L after treatment,the difference is statistically significant(P=0.000);Na~+before treatment:(139.94±4.59)mmol/L,after treatment Na~+(137.28±4.02)mmol/L,the difference is Statistically significant(P=0.013).Conclusion:The application of recombinant human brain natriuretic peptide for injection in patients with chronic kidney disease stage 3 to 5 combined with heart failure can significantly improve their cardiac and renal functions,reduce the level of plasma NT-proBNP,and has good safety.