Effects Of CRRT In Patients With Acute Decompensate Heart Failure

Objective:To investigate the effects of CRRT in patients with acute decompensated heart failure(ADHF).Methods:A retrospective analysis on 101 patients with acute decompensated heart failure who were hospitalized in the emergency department of Xinhua Hospital Affliated to Shanghai Jiaotong University School of Medicine from January 2015 to September 2018.According to whether received CRRT treatment,45 patients were divided into CRRT + conventional drug-treated group and 56 patients were divided into in conventional drug-treated group.The 28-days mortality,total net fluid output during hospitalization,the NT-pro BNP level at discharge,and the hospitalization cost were compared between the two groups,and the occurrence of adverse reactions during the treatment period was recorded.At the same time,all patients enrolled were followed up for 120 days after discharge,and the time of first heart failure event after discharge was recorded and the incidence of heart failure events at30 days,60 days,and 120 days was counted.There were 27 patients with AKI in the CRRT+ conventional drug-treated group.According to the creatinine and urine volume of patients before CRRT treatment,7 patients were divided into KDIGO 1 group,8 patients were divided into KDIGO 2 group and 12 patients were divided into KDIGO 3 group.The recovery of renal function at the time of discharge and 28-days mortality were compared during the three groups.RESULTS:Compared with the conventional drug-treated group,the CRRT+conventional drug-treated group had a longer median time of first heart failure event within 120 days after discharge(78 days vs.38 days,P=0.029),less incidence of heart failure events at 30 days,60 days(7.5% vs.23.1%,P=0.045;12.5% vs.34.6%,P=0.015)and more total net fluid output during hospitalization(13.10±9.70 L vs.9.25±5.08 L,P=0.038).The rate of new electrolyte disorder during treatment was significantly lower(8.9% vs.26.8%,P=0.022).There was no significant difference in 28-day mortality between the two groups(13.3% vs.7.1%,P=0.301),as well as the difference of NT-pro BNP level at discharge and baseline(-6933.55±12843.09 vs.-6726.69±17413.01,P=0.953).In the CRRT+ conventional drug-treated group,the KDIGO3 group had a significant reduction in the recovery of renal function compared with the other two groups(25% vs.100% vs.100%,P=0.001).There was no significant difference in 28-days mortality during the three groups(0% vs.12.5% vs.33.3%,P=0.171).Conclusion:CRRT can significantly improve the circulatory volume overload in ADHF patients,and it is associated with a prolonged clinical stabilization and a greater freedom from rehospitalization for heart failure with less effect on electrolytes.For patients with AKI,CRRT is beneficial for the recovery of renal function when the renal function is impaired moderately...