Vazir Ali, Simpkin Victoria L, Marino Philip, Ludman Andrew, Banya Winston, Tavazzi Guido, Bastin Anthony J, Trenfield Sarah, Ghori Arshad, Alexander Peter D, Griffiths Mark, Price Susanna, Sharma Rakesh, Cowie Martin R
Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; High Dependency Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, United Kingdom.
Department of Cardiology, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
Int J Cardiol. 2016 Oct 1;220:618-22. doi: 10.1016/j.ijcard.2016.06.186. Epub 2016 Jun 28.
Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality.
Seventeen patients with ADHF-DR underwent 20 treatments with UF. Serial bloods (4-6 hourly) from the onset of UF treatment were measured for renal function, electrolytes and central venous saturation (CVO2). Univariate and multivariate analysis were performed to assess the relationship between changes in markers of haemodynamics [heart rate (HR), systolic blood pressure (SBP), packed cell volume (PCV) and CVO2] and Δcreatinine. Patients were followed up and mortality recorded. Cox-regression survival analysis was performed to determine covariates associated with mortality.
Renal function worsened after UF in 17 of the 20 UF treatments (baseline vs. post UF creatinine: 164±58 vs. 185±69μmol/l, P<0.01). ΔCVO2 was significantly associated with Δcreatinine [β-coefficient of -1.3 95%CI (-1.8 to -0.7), P<0.001] and remained significantly associated with Δcreatinine after considering changes in SBP, HR and PCV [P<0.001]. Ten (59%) patients died at 1-year and 15(88%) by 2-years. Δcreatinine was independently associated with mortality (adjusted-hazard ratio 1.03 (1.01 to 1.07) per 1μmol/l increase in creatinine; P=0.02).
Haemodynamic changes during UF as measured by the surrogate of cardiac output was associated with Δcreatinine. Worsening renal function at end of UF treatment occurred in the majority of patients and was associated with mortality.
急性失代偿性心力衰竭伴利尿剂抵抗（ADHF-DR）患者预后较差。本研究旨在评估ADHF-DR患者超滤（UF）过程中的血流动力学变化是否与肾功能变化（肌酐变化量）相关，以及超滤后肌酐变化量是否与死亡率相关。
17例ADHF-DR患者接受了20次超滤治疗。从超滤治疗开始每4 - 6小时采集一次系列血样，检测肾功能、电解质和中心静脉血氧饱和度（CVO2）。进行单因素和多因素分析，以评估血流动力学指标变化[心率（HR）、收缩压（SBP）、血细胞比容（PCV）和CVO2]与肌酐变化量之间的关系。对患者进行随访并记录死亡率。进行Cox回归生存分析以确定与死亡率相关的协变量。
20次超滤治疗中有17次超滤后肾功能恶化（超滤前与超滤后肌酐：164±58 vs. 185±69μmol/l，P<0.01）。CVO2变化量与肌酐变化量显著相关[β系数为 -1.3，95%可信区间（-1.8至 -0.7），P<0.001]，在考虑SBP、HR和PCV变化后，CVO2变化量仍与肌酐变化量显著相关[P<0.001]。10例（59%）患者在1年时死亡，15例（88%）在2年时死亡。肌酐变化量与死亡率独立相关（肌酐每增加1μmol/l，调整后风险比为1.03（1.01至1.07）；P = 0.02）。
通过心输出量替代指标测量的超滤过程中的血流动力学变化与肌酐变化量相关。大多数患者在超滤治疗结束时肾功能恶化，且与死亡率相关。
