Effect of trimetazidine on renal function in patients with shock / 中华危重病急救医学

ABSTRACT

Objective To investigate the effects of trimetazidine on renal function in patients with shock.Methods A prospective randomized controlled double-blind study was conducted.128 patients with shock admitted to intensive care unit (ICU) of Guangzhou Red Cross Hospital from April 2011 to April 2013 were enrolled and randomly divided into control group and trimetazidine treatment group,each n＝64.All patients received anti-shock treatment,while the patients in trimetazidine group received trimetazidine treatment (20 mg orally,tid) for 7 days,and patients in control group received placebo (10 mL of sterile water for injection,tid) for 7 days.The urinary output,serum creatinine (SCr),blood urea nitrogen (BUN),cystatin C,and creatinine clearance (CCr) reflecting renal function were recorded in both groups,and the values were compared before treatment,48 hours after treatment,and 1 week after the treatment.At the same time,dynamic mean arterial pressure (MAP) was monitored,and 48-hour and 1-week mortality rates were recorded.Results There was no significant difference in results in all the renal function parameters before the treatment between two groups.The levels of SCr,BUN,cystatin C were gradually decreased after treatment in both groups,but CCr and MAP were gradually increased.Compared with the control group,cystatin C at 48 hours after treatment was significantly decreased,while CCr was significantly increased in treatment group [cystatin C (mg/L)0.85 ± 0.81 vs.1.01 ± 0.91,t=2.562,P=0.017; CCr (mL/s)0.93 ± 0.64 vs.0.69 ± 0.40,t=2.155,P=0.033].SCr and BUN at 1 week after treatment were significantly decreased in treatment group [SCr (lμmol/L)94.23 ± 88.31 vs.104.99 ± 98.37,t=2.921,P=0.003 ; BUN (mmol/L)9.46 ± 8.24 vs.11.87 ± 8.65,t=2.611,P=0.010].Urine output per hour and MAP was improved after treatment in both groups,and no significant difference was found between treatment group and control group [urine output (mL)48 hours after treatment 55.67 ± 31.43 vs.45.34 ± 11.79,t =0.934,P=0.323 ; 1 week after treatment 71.67 ± 37.23 vs.75.35 ± 22.88,t=1.280,P=0.210; MAP (mmHg,1 mmHg=0.133 kPa)48 hours after treatment 72.13 ± 33.24 vs.69.28 ± 39.98,t=1.408,P=0.179; 1 week after treatment 71.44 ± 21.98 vs.72.32 ± 31.11,t =1.184,P =0.252].Mortality rate in treatment group was lowered compared with control group,however no statistical significance was found [48 hours after treatment31.2％ (20/64) vs.32.8％ (21/64),x2=0.084,P=0.785; 1 week after treatment32.8％ (21/64) vs.35.9％ (23/64),x2=2.084,P=0.173].Conclusions Trimetazidine can improve renal function in patients with shock.