Abstract 12107: Continuous Renal Replacement Therapy for the Treatment of Acute Decompensated Heart Failure and Cardio-Renal Syndrome
Background: The worsening of renal function associated with acute decompensated heart failure (ADHF) is an important and common clinical scenario, for which continuous renal replacement therapy (CRRT) may be useful. However, it remains to be elucidated whether CRRT is also effective for ADHF patients with cardio-renal syndrome. In this study, we thus examined the effectiveness and therapeutic implications of CRRT in the management of ADHF associated with cardio-renal syndrome.
Methods and Results: We examined consecutive 38 ADHF patients (M/F 27/11, 68±15[SD] years, NYHA class III/IV 11/27) who were hospitalized to the coronary care unit of our hospital and required CRRT (continuous hemodiafiltration system, TORAY, Tokyo) between June 2003 and March 2011. The mean interval between admission and CRRT initiation was 5 days. Their left ventricular ejection fraction (LVEF) (38±11%) and estimated glomerular filtration rate (eGFR) (13±7 ml/min/1.73m2) were reduced in those patients. About half of them (55%) had ischemic heart disease and 21% of them needed mechanical circulatory support. Their in-hospital mortality was 37%, in contrast to 8% for all ADHF patients of our database (n=261) (P<0.001). When compared with the non-survivors (n=14), the survivors (n=24) showed better LVEF (43±11 vs. 31±9%, P<0.001) and greater urine volume during the first 24 hours after CRRT initiation (2,109±2,425 vs. 691±578 ml, P=0.039), while the last 24-hour urine volume before CRRT initiation was comparable (687±676 vs. 550±278 ml). In contrast, there was no significant difference in age, eGFR, hemoglobin, serum BNP level or doses of loop diuretics given just before CRRT initiation between the 2 groups. Multivariate Cox regression analysis showed that the first 24-hour urine volume after CRRT initiation (HR:0.998, 95%CI: 0.997-1.000, P=0.043) and serum CRP level (HR:1.090, 95%CI: 1.001-1.186, P=0.046) were independent predictors for in-hospital mortality.
Conclusions: These results indicate that patients with ADHF and cardio-renal syndrome have higher mortality when they require CRRT; however, the in-hospital outcome is better when they respond to CRRT.
- © 2011 by American Heart Association, Inc.