Second Department of Internal Medicine, University of Toyama.
Advocate Christ Medical Center.
Int Heart J. 2021 Sep 30;62(5):1052-1056. doi: 10.1536/ihj.21-202. Epub 2021 Sep 17.
Cardio-renal syndrome is a challenging clinical entity to manage, and is often associated with increased morbidity and mortality. We hypothesized that adaptive servo-ventilation (ASV), non-invasive positive pressure ventilation that ameliorates systemic/pulmonary congestion, may improve renal function in patients with symptomatic heart failure complicated by the cardio-renal syndrome. Patients with symptomatic congestive heart failure who underwent ASV therapy for over 1 month were included in this retrospective study. The trajectory of the estimated glomerular filtration ratio (eGFR) between the pre-1 month period and the post-one-month period (on ASV) were compared. A total of 81 patients (median 65 years old, 65 men) were included. eGFR decreased during the pre-1 month period from 52.7 (41.7, 64.6) down to 49.9 (37.3, 63.5) mL/minute/1.73 m (P < 0.001) whereas we observed an increase following one-month of ASV therapy up to 53.4 (38.6, 68.6) mL/minute/1.73 m (P = 0.022). A reduction in furosemide equivalent dose following the initiation of ASV therapy was independently associated with increases in eGFR with an adjusted odds ratio of 13.72 (95% confidence interval 3.40-55.3, P < 0.001). In conclusion, short-term ASV therapy was associated with the preservation of renal function, particularly when the dose of loop diuretics was concomitantly reduced.
心肾综合征是一种具有挑战性的临床病症，常伴有发病率和死亡率的增加。我们假设适应性伺服通气（ASV）——一种改善全身/肺部充血的无创正压通气——可能改善伴有心肾综合征的症状性心力衰竭患者的肾功能。这项回顾性研究纳入了接受 ASV 治疗超过 1 个月的症状性充血性心力衰竭患者。比较了 1 个月前（ASV 治疗前）和 1 个月后（ASV 治疗后）的估算肾小球滤过率（eGFR）轨迹。共纳入 81 例患者（中位年龄 65 岁，65 名男性）。eGFR 在 1 个月前从 52.7（41.7，64.6）降至 49.9（37.3，63.5）mL/min/1.73 m（P<0.001），而在接受 1 个月 ASV 治疗后增加至 53.4（38.6，68.6）mL/min/1.73 m（P=0.022）。ASV 治疗开始后速尿等效剂量的减少与 eGFR 的增加独立相关，调整后的优势比为 13.72（95%置信区间 3.40-55.3，P<0.001）。总之，短期 ASV 治疗与肾功能的保存相关，尤其是当同时减少袢利尿剂的剂量时。
