Cor Vasa 2010, 52(3):121-126 | DOI: 10.33678/cor.2010.036

Acute renal failure requiring use of continuous renal replacement therapy methods in the coronary care unit of a cardiac center

Jan Bělohlávek^*, Vladimír Dytrych, Tomáš Kovárník, Ondřej Šmíd, Aleš Linhart

II. interní klinika kardiologie a angiologie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Introduction: Acute renal failure (ARF) requiring the use of renal replacement therapy methods is associated with a fairly poor prognosis of the critically ill, high mortality rates, and occurs in approximately 1-6% surgical and cardiac surgical patients. The incidence and relevance of ARF requiring the use of continuous renal replacement therapy methods has not been well characterized to date.

Aim: To determine the incidence of ARF requiring the use of continuous renal replacement therapy methods in the general population of the critically ill in the coronary care unit of a cardiac center and to define the short-term mortality rates of these patients.

Methods: Retrospective-prospective follow-up of all consecutive patients with ARF requiring the use of a continuous renal replacement therapy method in the authors' center over a period of more than seven years.

Results: Our group of patients comprised a total of 122 patients, i.e., 2% of 6,185 hospitalized patients over the study period. The most frequent causes of ARF included acute myocardial infarction in 36 (29%) patients, heart failure without cardiogenic shock in 64 (52%), with cardiogenic shock in 29 (24%), cardiac arrest with cardiopulmonary resuscitation in 26 (21%); 11 (9%) patients had had recent cardiac surgery, and a serious degree of pulmonary hypertension was present in 16 (13%) patients. The intensive care unit mortality was 42%, the 30-day mortality rate was 52%. Univariate logistic regression analysis identified cardiogenic shock, mechanical ventilation, catecholamine support, and sepsis as predictors of short-term mortality.

Conclusion: Acute renal failure requiring the initiation of continuous renal replacement therapy developed in 2% of patients hospitalized in the coronary care unit of our heart center. These patients make up an at-risk subgroup with acceptable short-term mortality. Our experience confirms the need to manage ARF as a complication of a variety of acute heart conditions and the appropriateness of mastering the technique of continuous renal replacement therapy in intensive care units taking care of individuals with acute heart conditions.

Keywords: Acute renal failure; Continuous renal replacement therapy methods; Coronary care unit; Heart center

Published: March 1, 2010  Show citation