Timing And Prognosis Of Patients With Type 1 Cardiorenal Syndrome Requring Renal Replacement Therapy

Objective:Renal replacement therapy(RRT)can be applied in cardiorenal syndrome(CRS)patients with invalid conventional treatment.The purpose of this retrospective study was to explore initiating and ending clinical feature,as well as the prognosis of RRT in patients with type 1 CRS.Methods:We retrospectively analyzed fifty-two patients who were admitted for type 1 CRS from May 2009 to April 2015 and carried out RRT in the Jiangsu Province Hospital.They were divided into three groups according to the prognosis-renal replacement therapy(RRT)independence,RRT dependence and death.The three groups were compared in demographic characteristics,primary cardiac disease,disease severity score(APACHE ? score and SOFA score),complication,baseline laboratory parameters,baseline heart and kidney function,drugs before RRT,RRT parameters,RRT initiating indications(hemodynamic parameters,serum creatinine,serum urea nitrogen,urine volume,fluid balance)and the prognosis.Results:Fifty-two patients were enrolled and they were 27 males and 25 females with the mean ages of 70.7±16.1 years old.The mean APACHE ? scores and SOFA scores were 14.4±4.2 and 8.7±4.7,respectively.90-day mortality rate was 65.4%.Combining with chronic kidney disease(26.5%)and the median baseline serum creatinine(92?mol/L)were lower in death group comparing with the survival group(including RRT dependence group and RRT independence group).The mean urine output of RRT independence group was 800ml/24h,much greater than RRT dependence group(650ml)and death group(345ml)before the initiation of RRT.Additionally,the fluid balance were obviously different among the three group(167ml?250ml?1270ml,respectively).At the ending of RRT;the mean urine output and fluid balance were remarkably different between RRT independence and RRT dependence group(1350ml vs 265ml,-350ml vs 850ml).A multivariate Cox regression approach showed that the risk factors for death were low left ventricular ejection fraction,low serum albumin,high APACHE ? scores and positive fluid balance.Conclusion:Refractory type 1 CRS using RRT for rescue therapy was associated with high mortality.The risk factors for death were low left ventricular ejection fraction,low serum albumin,high APACHE ? scores and positive fluid balance.The mean fluid balance of survivors was remarkably less than that of the death group at the initiating time of RRT.Meanwhile,when the urine output of patients reached to 1000ml/24h and the volume balance was negative,terminating RRT could be considered.