The Effect Of Fixed-date Intermittent Diuresis Treatment On The Cardiac And Renal Function Of Outpatients With Chronic Heart Failure

Objective:The purpose of this study was to evaluate the effectiveness of fixed-date intermittent diuresis and to explore how fixed-date intermittent diuresis affacts the cardiac function and renal function on outpatients with chronic heart failure and different renal function by observing the change of plasma levels of RAAS hormones, inflammatory mediators(TNF-a, IL-6),NT-proBNP, indexes of renal function (SCr、BUN、eGFR)and discussing the relationship between NT-proBNP and SCr、BUN、eGFR.Methods:We selected57outpatients,male31and female26, with chronic heart failure.All patients were divided them into three groups according to renal function classification,one group with normal renal function,one group with decreased renal function (133umol/L≤Scr≤177umol) and one group with renal Nitrogen qualitative hematic disease (178umol≤Scr≤265umol). All patients accepted fixed-date intermittent diuresis treatment. We detected the plasma levesls of RAAS hormones、inflammatory mediators、NT-proBNP、SCr、BUN、eGFR before and during treatment in all groups and Self-contrast and follow-up study was performed to explore the relationships between them.Results:1.There were no statistically significant differences found among the three groups on age gender and other conditions (P>0.05)2. Group comparison showed that before fixed-date intermittent diuresis treatment, there were statistically significant differences for RAAS hormones, inflammatory mediators, NT-proBNP、SCr、BUN in renal Nitrogen qualitative hematic disease group when compared to normal renal function group and decreased renal function group (P<0.01). eGFR of normal renal function group was higher than the decreased and Nitrogen qualitative hematic disease renal function groups (P<0.01).The plasma levels of RAAS hormones, inflammatory mediators(TNF-a、IL-6)、 NT-proBNP were higher in Nitrogen qualitative hematic disease renal function group than in normal renal function group and decreased renal function group after12monthes of treatment. There were not statistically significant differences between normal renal function group and decreased renal function group in Scr、BUN and eGFR (P>0.05), but there were statistically significant differences between normal renal function group and Nitrogen qualitative hematic disease renal function group (P<0.01)3. In normal renal function group,the plasma levels of RAAS hormones、inflammatory mediators(TNF-a、IL-6)、 NT-proBNP were lower after the treatment when compared to those of before treatment (P<0.01). But no significant difference for the index of renal funtion (Son BUN、eGFR) was found (P>0.05)4. In decreased renal funtion group, there were statistically significant differences in the plasma levels of RAAS hormones、inflammatory mediators (TNF-a、IL-6)、 NT-proBNP、SCr, BUN and eGFR after treatment when compared to those of before treatment (P<0.01)5. In Nitrogen qualitative hematic disease renal funtion group, there were statistically significant differences in the plasma levels of RAAS hormones, inflammatory mediators (TNF-a、IL-6) and NT-proBNP after treatment when compared to those of before treatment (P<0.01); no significant difference for the index of renal funtion (Scr、BUN、eGFR) after treatment one mouth (P>0.05), significant difference for the index of renal funtion (Scr、BUN、eGFR) after treatment six and twelve mouthes was found (P<0.05)6. Correlation analysis showed that there were significantly positive correlation between plasma level of NT-ProBNP and that of Scr (r=0.429, P<0.01) and BUN (r=0.247, P<0.01) respectively, a negative correlation between plasma level of NT-ProBNP and eGFR (r=-7.257, P<0.01) Conclusion:1. This research shows that:fixed-date intermittent diuresis can decrease the plasma levels of RAAS hormones、inflammatory mediators (TNF-a、IL-6)、NT-proBNP、 SCr、BUN and increase eGFR. The therapy can improve both cardiac function and renal function, and this method is simple、good adherence、safe and feasible.2. There are significant correlation between the plasma levels of NT-ProBNP and SCr、BUN and eGFR.:significantly positive correlation between plasma level of NT-ProBNP and that of Scr (r=0.429, P<0.01) and BUN (r=0.247, P<0.01) respectively, a negative correlation between plasma level of NT-ProBNP and eGFR (r=-7.257, P<0.01)...