Evaluati̇on of clinical results of volume load in Type 2 cardiorenal syndrome

EVALUATİON OF CLINICAL RESULTS OF VOLUME LOAD IN TYPE 2 CARDIORENAL SYNDROME Purpose: Cardiorenal syndrome is the coexistence of cardiac dysfunction and renal dysfunction. Type 2 CRS is the decrease in kidney function due to chronic heart disease. In this study, we analyzed the echocardiographic findings, bioimpedance electrical analysis results, laboratory tests, and patient groups who were treated with diuretic or ultrafiltration during hospitalization and discharge in patients diagnosed with Type 2 cardiorenal syndrome and volume overload. We aimed to contribute to the literature on the efficacy and safety of these treatments. Methods: Between April 1, 2021 and February 1, 2022, 61 patients with a diagnosis of Type 2 CRS and volume overload who were admitted to the Dicle University Faculty of Medicine Nephrology and Cardiology clinic and intensive care unit were prospectively analyzed. We examined the general characteristics of the patients included in the study at the time of diagnosis, laboratory values during hospitalization and discharge, echocardiographic findings, bioimpedance electrical analysis results, survival and mortality-related factors. Results: Our study consisted of 61 cases aged between 35 and 88 (67.97±13.265), 32 (52,5%) female and 29 (47,5%) male. Forty-two (68,9%) of the cases received diuretic therapy and 19 (31,1%) were receiving ultrafiltration therapy. Pretibial edema, NYHA class and proteinuria in complete urinalysis were higher in the ultrafiltration group(p<0,05). It was observed that the patients in the ultrafiltration group were mostly followed in the intensive care unit(p<0,05). In addition, it was observed that patients in the ultrafiltration group were included in more routine hemodialysis programs in the follow-ups(p<0,05). It was observed that the number of days hospitalized and the number of re-admissions to the hospital within two months were higher in patients who received ultrafiltration therapy(p<0,05). It was found that NT proBNP, creatinine, proteinuria in spot urine and proteinuria in complete urinalysis were higher in the group that received ultrafiltration treatment(p<0,05). GFR was higher in the group receiving diuretic therapy(p<0.05). Inlet and outlet creatinine values were found to be higher in those receiving ultrafiltration treatment(p<0.05). On the contrary, LAV output value was found to be higher in the group receiving diuretic therapy(p<0.05). The results obtained from the pre-treatment and post-treatment echocardiography of the patients showed a significant difference in the input and output values of the VCI, PABS and LAV variables in cases who received both diuretic and ultrafiltration treatment(p<0.05). In addition, there was a difference in the entry and exit values in the mitral regurgitation variable in cases receiving diuretic therapy(p<0.05). In the differences obtained from the input and output values in echocardiography parameters, a greater decrease was observed in the LAV variable in the ultrafiltration group(p<0.05). When the kilograms (KG) and BIA measurements of the patients were examined, a decrease was observed in both groups in terms of overhydration, extracellular fluid, OH/ECW ratio, total body water, E/I ratio, and entry and exit values(p<0,05). When the biochemistry parameters of the patients were examined, there were differences in the input and output values of the NA, K and GFR variables in both groups(p<0.05). In addition, differences were observed in albumin values in patients receiving diuretic therapy, and in urea, creatinine and uric acid variables in patients receiving ultrafiltration therapy(p<0.05). In the differences obtained from the input and output values of the variables in the biochemistry parameters, a higher increase was observed in the creatinine and calcium variables in the ultrafiltration group(p<0.05). In the results obtained, NYHA class and NTproBNP values were found to be statistically significantly higher in the deceased patient group(p<0.05). As a result of univariate logistic regression analysis to evaluate the factors associated with mortality, NTproBNP, NYHA class, creatinine value and PABS variables were found to be associated with mortality. The independent variables that were significant in the univariate logistic regression analysis and the results obtained in the multivariate logistic regression analysis showed a significant relationship between NYHA class and PABS level (p<0.05). Conclusion: Type 2 CRS is still a disease that requires frequent hospitalization and has a poor prognosis. Reducing the volume load in patients may improve clinical, laboratory and echocardiographic findings. Volume load can be reduced with diuretic or UF therapy. UF is considered a more appropriate approach in patients with diuretic resistance. NYHA functional class and NTproBNP value are mortality-related independent variables.