Effect of continuous blood purification in the treatment of cardiorenal syndrome type I

Abstract

Objective To evaluate the effect of continuous blood purification (CBP) on cardiorenal syndrome (CRS) type Ⅰ. Methods Clinical data of 42 patients with CRS type Ⅰ at our hospital were collected from January 2012 to June 2014. We observed and compared changes in mean arterial pressure (MAP), heart rate, respiration rate, acute physiology and chronic health evaluation (APACHE) Ⅱ score, and urinary volume before and 5 days after CBP. Meanwhile, levels of serum creatinine (Scr), cysteine proteinase inhibitor Cystatin C (CysC), serum creatinine (cTn) and B-type natriuretic peptid (BNP) were monitored. In addition, dynamic changes in cardiac index (CI), intrathoracic blood volume index (ITBI), global end-diastolic volume index (GEDI), central venous pressure (CVP), and extravascular lung water index (ELVWI) were monitored using the pulse induced contour cardic output plus monitoring system (PiCCO plus), and changes in left ventricular ejection fraction (LVEF) before and 5 days after CBP was measured by color Doppler ultrasound. Results There was no significant difference in MAP in patients with CRS type I before and 5 days after CBP (P=0.08). Tachycardia and tachypnea improved, while urine volume increased and the APACHE Ⅱ score decreased significantly, 5 days after CBP (allP<0.05). Plasma levels of Scr, CysC, cTn and BNP after treatment were lower than those before treatment 〔(126.8±68.3) μmol/L vs. (413.6±126.1) μmol/L, (1.1±0.8) g/L vs. (4.1±1.1) g/L, (2.6±0.4) μg/L vs. (3.5±0.7) μg/L, (807.6±427.7) ng/L vs. (3300.3±567.6) ng/L, all P<0.05)〕. Myocardial contractility, cardiac preload and lung related parameters also significantly improved after CBP (allP<0.05). Conclusions CBP can alleviate clinical symptoms of CRS type I, improve cardiac and renal function, and is promising as an important auxiliary measure for the treatment of patients with cardiorenal syndrome type I. Key words: Cardiorenal syndrome; Hemofi ltration