关键词: 心肾综合征, 连续性肾脏替代治疗, 预后

Abstract:

ABSTRACT Objective: To explore initiating and ending clinical feature, as well as the prognosis of continuous renal replacement therapy (CRRT) in patients with type 1 cardio-renal syndrome (CRS). Methodology: Fifty-two patients who were admitted for type 1 CRS from May 2009 to April 2015 and carried out CRRT in the Jiangsu Province Hospital were enrolled into this retrospective study. 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 the baseline index, diagnosis, complication, drugs before CRRT, CRRT initiating indications and the prognosis. Results: They were 27 males and 25 females with the mean ages of 70.7±16.1 years old. The mean APACHE II scores and SOFA scores were 14.4±4.2 and 8.7±4.7, respectively. Mortality rate was 65.4%. The mean urine output of RRT independence group were 800ml/24h, much greater than that of RRT dependence group (650ml) and death group (345ml) before the initiation of CRRT. Additionally, the fluid balance were obviously different among the three group (167ml、250ml、1270ml, respectively). At the ending of CRRT, the mean urine output and fluid balance were remarkably different between RRT independence and RRT dependence group (1350ml vs 265ml, -460ml vs 760ml). A multivariate Cox regression approach showed that the risk factors for death were low left ventricular ejection fraction, low serum albumin, high APACHE II scores and positive fluid balance. Conclusion: Refractory type 1 CRS using CRRT for rescue therapy was associated with high mortality. The risk factors for death were low left ventricular ejection fraction, low serum albumin, high APACHE II scores and positive fluid balance. The mean fluid balance of survivors (RRT dependence and RRT independence）were remarkably less than the death group at the initiating time of CRRT. Meanwhile, when the urine output of patients reached to 1000ml/24h and the volume balance was negative, terminating CRRT could be considered.

Key words: cardiorenal syndrome, continous renal replacement therapy, prognosis